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Preoperative anemia in patients with cancer is multifactorial, with one‐third of patients having iron deficiency at presentation [3, 16]. The negative impact of preoperative anemia on surgical outcomes is well known. A multivariate analysis of 39 309 patients undergoing major surgery showed that severe anemia was associated with higher in‐hospital mortality (odds ratio (OR) 2.82, 95% confidence interval (CI) 2.06–3.85) and postoperative admission to intensive care (p < 0.001) [17]. A systematic review and meta‐analysis reported increased acute kidney injury and infection in patients with preoperative anemia [18]. On the other hand, allogenic red cell transfusion, which occurs at a higher rate among anemic patients, is also associated with increased mortality and morbidity [3, 18]. Therefore, in order to reduce the risk of postoperative complications, it is necessary to correct anemia before surgery. Oral iron replacement is not always effective in patients with cancer because of the time required for its efficacy and because its action is limited by the inflammation. Therefore the intravenous (IV) treatment option is the most indicated. A single dose of IV ferric carboxymaltose (15 mg/kg body weight) in patients with ferritin < 300 mcg/l, transferrin saturation < 25%, and Hb < 12.0 g/dl for women and Hb < 13.0 g/dl for men has been shown to reduce the need of transfusion during major abdominal surgery in 60% of patients [16].

Figure 5.1 Preoperative care.