Alexandre Ferreira Oliveira

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.

Although ovarian cancer is the most lethal among gynecological cancers, access to massive BRCA testing is still limited. Its cost‐effectiveness is still a topic of discussion in several countries. In Brazil, olaparib was recently incorporated into the public health system, access to BRCA testing is still limited. In this article, we aim to review the cost‐effectiveness of offering BRCA testing to the at‐risk population. A working group composed of 14 specialists in surgical oncology and cancer genetics was established to discuss the cost‐effectiveness of population‐based BRCA testing for ovarian cancer. The project was divided into five main areas, each with subtopics assigned among the 14 participants. They were: the existing clinical testing guidelines, the current healthcare infrastructure in the Brazilian public health system, cost‐effectiveness analysis, challenges in implementing prophylactic surgeries, and family counseling and risk communication. A comprehensive literature review was conducted, followed by a series of meetings among the article's contributors to reach consensus on unresolved issues. These discussions aimed to build recommendations based on the best available scientific evidence. Using as a basis the current structure already existing within the Brazilian public health service (SUS [Sistema Único de Saude]), and based on the testing of the at‐risk population chosen by our experts, we estimated savings. The net savings for a population of 100 000 women would range from BRL 7030.30 (US$1255.41) to BRL 1853.92 (US$331.05). And these costs could have an even greater impact when public service PARP inhibitors are incorporated. The working group of the Brazilian Society of Surgical Oncology understands that large‐scale BRCA testing is cost‐effective, especially when risk‐reducing surgery is implemented. Other measures are important, such as training teams of non‐specialists to recognize the population at risk, in addition to creating an entire line of care for patients with ovarian cancer in the SUS.

Introduction: The Brazilian Society of Surgical Oncology (SBCO) developed national guidelines for the rational use of blood concentrates in surgical procedures. Methods: Between June and December 2024, a multidisciplinary team of 42 experts formulated 48 key questions on the rational use of blood concentrates in surgery. The guidelines were structured in three phases: preoperative, intraoperative, and postoperative. Expert groups performed literature reviews and proposed preliminary recommendations, which were later refined by the coordinators. An adapted grading system was used to assess the level of evidence, and an online voting process determined consensus among experts. Conclusion: Implementing a bloodless surgery protocol requires a meticulous and coordinated approach across multiple medical disciplines. Essential elements for success include patient and staff education, comprehensive preparation, and the use of advanced surgical techniques and technologies to optimize outcomes.

Background: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality and represents a growing public health challenge. Aims: To develop multidisciplinary evidence-based recommendations for the prevention and early detection of HCC. Methods: This consensus was coordinated by the Brazilian Society of Surgical Oncology, with the participation of 13 additional national societies. A steering committee defined the key clinical questions addressing prevention, surveillance, and early detection strategies. Recommendation statements were informed by a comprehensive, non-systematic review of the literature conducted using PubMed, Scopus, and the Cochrane Library. Results: Eighteen recommendations reached consensus, covering three main domains: (1) Primary prevention, including HBV vaccination, timely antiviral therapy for viral hepatitis, and lifestyle interventions for metabolic dysfunction. (2) Secondary prevention, outlining risk-based surveillance strategies for patients with advanced fibrosis or cirrhosis due to HBV, HCV, or MASLD. (3) Operational standards for surveillance, emphasizing ultrasound as the cornerstone of monitoring, the importance of structured reporting, management of small nodules, and the selective use of cross-sectional imaging. Conclusions: These multidisciplinary recommendations provide practical, adaptable guidance for HCC prevention, surveillance, and early detection. This guidance document aims to reduce the burden of HCC and support better clinical outcomes across diverse healthcare settings.

Locally advanced breast carcinoma (LABC) is a frequent condition in Brazil and in developing countries. Neoadjuvant systemic therapy (NST) has allowed for surgical de‐escalation of the breast and/or axilla, leading to increasing the rates of breast‐conserving‐surgery, skin/nipple preservative mastectomies and axillary preservation. There are no established quality indicators for LABC or NST. This article aimed to review the topic, highlighting Brazilian studies, identifying thirty potential quality indicators for surgical treatment.

Background and Objective: Palliative surgery in oncology aims to relieve symptoms, improve quality of life, and respect patient autonomy in advanced cancer. This study aimed to develop evidence‐based recommendations for safely indicating and performing palliative surgeries in Brazil, considering clinical, ethical, and multidisciplinary aspects. Methods: A modified Delphi consensus was conducted with nine experts from the Brazilian Society of Surgical Oncology, including surgical and clinical oncologists, palliative care specialists, and a psychologist. Sixteen key recommendations were formulated based on literature review and a national survey identifying gaps in training, communication, and technical safety. Consensus was defined as ≥ 80% agreement, achieved in a single round. Results: Recommendations emphasize individualized patient selection based on functional status, frailty, prognosis, and symptom severity. Multidisciplinary evaluation, shared decision‐making, clear communication, and consideration of minimally invasive techniques were prioritized. Palliative procedures focus on symptom control rather than survival extension, with evidence supporting improved quality of life, reduced hospital admissions, and enhanced oral intake. Conclusions: Palliative surgery should be guided by strict clinical criteria, multidisciplinary planning, and patient‐centered communication. Active patient participation, ethical deliberation, and evidence‐based practices ensure safe, effective, and humanized care, avoiding futile or disproportionate interventions.

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with a rising incidence largely driven by chronic liver disease. Accurate diagnosis and appropriate clinical assessment at the time of presentation are essential, as therapeutic strategies and prognosis depend on tumor burden, liver function, portal hypertension, and patient performance status. Aim: To develop evidence-based, multidisciplinary recommendations to guide the diagnosis, clinical assessment, and staging of patients with HCC. Methods: This consensus was developed by 43 experts from surgical oncology, hepatology, clinical oncology, radiology, interventional radiology, pathology, liver transplantation, gastroenterology, radiation oncology, and palliative care, under the coordination of the Brazilian Society of Surgical Oncology and 13 collaborating national medical societies. A scientific steering committee predefined clinically relevant questions addressing radiological and histopathological diagnosis, clinical assessment, diagnostic work-up, management of patients at the time of HCC diagnosis, and staging. These questions were discussed and refined in multidisciplinary meetings and submitted to structured voting rounds. Results: The panel formulated 18 recommendations covering key aspects of HCC evaluation, including standardized application of Liver Imaging Reporting and Data System (LI-RADS®) for imaging-based diagnosis, management of indeterminate lesions, indications for biopsy, histopathological classification and reporting, immunohistochemical markers, assessment of hepatic function and portal hypertension, staging systems, diagnostic work-up, and the role of multidisciplinary care. The recommendations emphasize integration of imaging findings with liver-related factors and clinical context to support individualized decision-making. Conclusions: This multidisciplinary consensus provides practical, evidence-based recommendations for the diagnosis, clinical assessment, and staging of HCC. By promoting standardized diagnostic practices while reinforcing comprehensive patient evaluation and multidisciplinary management, this document aims to improve diagnostic accuracy, optimize treatment selection, and support safe care.

The BSSO developed the present guidelines to provide recommendations based on current scientific evidence that is focused on the main topics related to the daily surgical practice of lymphadenectomy in colorectal cancer. Between October 2024 and February 2025, nine experts met to develop the guidelines for the lymphadenectomy in colorectal cancer. These guidelines summarize concisely the recommendations based on the most current scientific evidence on the most relevant aspects of the lymphadenectomy in colorectal cancer.

Exocrine pancreatic insufficiency (EPI) in oncology patients requires careful attention due to its clinical significance and frequent underdiagnosis. This narrative review and Guideline established by the Brazilian Society of Surgical Oncology suggest a practical approach to diagnosis and pancreatic enzyme replacement therapy (PERT). This promising approach can improve symptoms, nutritional status, and quality of life, potentially positively impacting survival in unresectable pancreatic cancer and postsurgical settings.

Neoplastic pleural effusion is one in which malignant neoplastic cells are detected in the pleural fluid or in the parietal pleura. When secondary, it confirms disseminated neoplastic disease and suggests a reduced life expectancy and low quality of life. This review was described by a group of physician members of the Brazilian Society of Oncological Surgery regarding the treatment of neoplastic pleural effusion, developed to guide surgeons, palliative care physicians and clinical oncologists in their clinical practice to assess patients indicated for pleurodesis based on survival scores.