Brazilian Society of Surgical Oncology Guideline for Bloodless Surgery (Part 3: Postoperative Strategies)
Ronald Enrique Delgado Bocanegra, Alexandre Ferreira Oliveira, Vandre Cabral Gomes Carneiro, Reitan Ribeiro, Romilton Machado, Luis Fernando Johnson, Daniel Cesar, Roberta Oliveira de Almeida, Marcio Sanctos Costa, Augusto Fernandes Mendes, Larissa de Jesus Almeida, Thomas Augusto Rodrigues de Magalhães, Carlos Eduardo Santa Ritta Barreira, Kleuber Moreira Lemos, Felipe Jose Fernandez Coimbra, Joyce Sant'Anna Barros Lyra, Paulo Henrique de Sousa Fernandes, Angelo Atalla, Nathalia Moreira Ramalho, Marcelo Bentancor Lontra, Marcos Gonçalves Adriano Junior, Suellen Riccio Simões, Luccas Melo Chagas, João Rosa de Almeida, Vinicius La Rocca Vieira, Jorge Soares Lyra, Arthur Foinquinos Krause Goncalves, Elves Maciel, Vicente Faraon Fonseca, Abraão Elias Hallack Neto, Luiz Carlos Von Bahten, Adroaldo Guimarães Rossetti Junior, Murilo Pereira Flores, Yan Vitor Gomes Silva de Jesus, Giovani Alves Monteiro, Pedro Eder Portari Filho, Heladio Feitosa e Castro Neto, Diego Venicio Santos Argolo, Rinailda de Cascia Santos Torres, Rodrigo Nascimento PinheiroABSTRACT
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.