Cardiopulmonary bypass and cancer dissemination and progression: myth reality, enigma, puzzle?

Cardiac disease (CD) and oncologic disease (OD) are among the most lethal diseases. Both share common risk factors and as a consequence, there are a substantial number of patients who need surgeries for problems related to both diseases. Treatments for OD should start as soon as possible, as the disease can progress and disseminate, reducing life expectancy for patients. At times, heart problems may need cardiac surgery (CS), which are sophisticated and peculiar, at many times needing a machine to do the lung and the heart function as the surgeon does his job. This is called cardiopulmonary bypass (CPB), a procedure that is known to be related to inflammation and immunosuppression syndromes, that could lead the cancer disease to disseminate. There is little information on this subject in the literature so, in this narrative review, we have made a literature review, trying to address whether this theoretical worry confirms at evidencebased medicine. We also described some considerations regarding the use of devices like Cell Saver (R) and autotransfusion in oncologic patients. Further, we have taken some considerations about what care should be taken when facing situations with patients of different stages of OD needing CS and what should be discussed multidisciplinary aiming a treatment that best fits patient's life -expectancy and clinical status.