Brazilian Society of Surgical Oncology Guideline for Bloodless Surgery (Part 3: Postoperative Strategies)
OBJECTIVE: To present postoperative strategies for bloodless surgery in oncologic patients, focusing on anemia management, bleeding control, oxygen delivery, and recovery without allogeneic blood transfusion. METHODS: The Brazilian Society of Oncologic Surgery developed national recommendations for the rational use of blood products in surgical care. Between June and December 2024, a multidisciplinary panel of specialists reviewed the literature and formulated key questions covering preoperative, intraoperative, and postoperative management. Recommendations were graded using an adapted evidence classification system and validated through expert consensus. RESULTS: Postoperative bloodless care should prioritize judicious laboratory testing to reduce iatrogenic anemia, targeted iron replacement, selective use of erythropoiesis-stimulating agents, individualized hemostatic therapy, early recognition and control of hemorrhage, and optimization of oxygen delivery. General postoperative measures, including mobilization, analgesia, infection prevention, rehabilitation, and discharge planning, should be retained when directly related to anemia tolerance, blood conservation, or recovery in patients managed without transfusion. CONCLUSION: Postoperative bloodless surgery requires coordinated multidisciplinary care, early bleeding control, anemia treatment, oxygen delivery optimization, and careful follow-up. These strategies may improve safety and recovery in oncologic patients who decline or require avoidance of allogeneic blood transfusion.
Authors
- Heládio FEITOSA
- A. Gonçalves (ORCID: https://orcid.org/0000-0002-4082-603X)
- Reitan Ribeiro (ORCID: https://orcid.org/0000-0002-4323-3854)
- Vicente Faraon Fonseca (ORCID: https://orcid.org/0009-0009-8903-7785)
- Rinailda de Cascia Santos Torres
- Kleuber Moreira Lemos
- Marcelo Bentancor Lontra
- Marcos Gonçalves Adriano (ORCID: https://orcid.org/0000-0001-7399-1659)
- Murilo Pereira Flores
- Vinícius La Rocca Vieira
- Ângelo Atalla (ORCID: https://orcid.org/0000-0002-5693-2443)
- Vandré Cabral Gomes Carneiro (ORCID: https://orcid.org/0000-0001-8776-8837)
- Paulo Henrique de Sousa Fernandes (ORCID: https://orcid.org/0000-0001-5476-2017)
- Ronald Enrique Delgado Bocanegra (ORCID: https://orcid.org/0000-0002-1048-5553)
- Carlos Eduardo Santa Ritta Barreira (ORCID: https://orcid.org/0000-0002-2126-1811)
- Abraão Elias Hallack Neto
- Rodrigo Nascimento Pinheiro (ORCID: https://orcid.org/0000-0002-2715-7628)
- Yan Vitor Gomes Silva de Jesus (ORCID: https://orcid.org/0000-0001-6811-2146)
- Jorge Soares Lyra (ORCID: https://orcid.org/0000-0001-7400-829X)
- Adroaldo Guimarães Rossetti (ORCID: https://orcid.org/0000-0002-0150-4089)
- Nathalia Moreira Ramalho (ORCID: https://orcid.org/0000-0001-8047-1037)
- Diêgo Venicio Santos Argôlo
- Felipe José Fernández Coimbra (ORCID: https://orcid.org/0000-0001-5068-0639)
- Giovani Alves Monteiro
- Alexandre Ferreira Oliveira (ORCID: https://orcid.org/0000-0002-7500-6752)
- Luccas Melo Chagas (ORCID: https://orcid.org/0009-0003-5675-7176)
- Larissa de Jesus Almeida (ORCID: https://orcid.org/0000-0002-5978-5549)
- Elves Maciel
- Romilton Machado
- Augusto Fernandes Mendes
- Joyce Sant'Anna Barros Lyra
- Suellen Riccio Simões
- Marcio Sanctos Costa
- Thomas Augusto Rodrigues de Magalhães
- Daniel Cesar
- Luis Fernando Johnson
- Roberta Oliveira de Almeida
- Pedro Eder Portari Filho
- João Rosa de Almeida
- Luiz Carlos Von Bahten
Institutions
- Universidade Federal de Juiz de Fora (BR)
- Universidade Federal de Sergipe (BR)
- Universidade Estadual de Feira de Santana (BR)
- AC Camargo Hospital (BR)
- Hospital Moinhos de Vento (BR)
- Real Hospital Português (BR)
- Hospital Universitário - Universidade Federal de Juiz de Fora (BR)
- Hospital Universitário Gaffrée e Guinle (BR)
- Hospital Erasto Gaertner (BR)
- Hospital de Câncer de Pernambuco (BR)
- Instituto de Medicina Integral Professor Fernando Figueira (BR)
- Hospital Santa Izabel (BR)
- Hospital Haroldo Juaçaba (BR)
- Universidade Ceuma (BR)
- Hospital Ernesto Dornelles (BR)
- Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão (BR)
- Hospital Universitário de Brasília (BR)
- Centro Universitário Academia (BR)
- Universidade Federal de Uberlândia (BR)
Publication Details
- Journal
- Journal of Surgical Oncology
- Published
- 2026-09-30
- DOI
- https://doi.org/10.1002/jso.70348
- Primary Topic
- Blood transfusion and management
- Type
- article
- Field-Weighted Citation Impact
- 0.00