Perioperative anemia and blood transfusion are currently considered independent risk factors for poor outcome in surgical patients. In addition, in oncologic patients, both may enhance cancer growth and metastasis. Patient Blood Management (PBM) strategies are recommended to minimise these risks. The specific PBM strategies in surgical cancer patients are insufficiently defined. Primary objective -To evaluate the perioperative hemoglobin (Hb) levels variation, Secondary objectives -To identify the prevalence of perioperative anemia and transfusion rate in surgical oncologic patients.

Introduction: Critically ill patients develop anemia due to several reasons: bleeding prior or during intensive care unit (ICU) stay, frequent flebotomies, hemodilution and inflammatory status with altered erythropoiesis. The aim of this study was to assess the trend of hemoglobin (Hb) level during long ICU stay (more than 7 days) in transfused and nontransfused patients. Materials and Methods: We conducted a prospective observational study that included all patients with long ICU length of stay (LOS) admitted during 1 year in a 19-beds mixed ICU of a tertiary care university hospital. Patients were divided into two groups: never transfused (NT) and ever transfused (ET) according to their transfusional status during ICU stay. Collected data: demographic data, severity scores, Hb values during ICU stay transfusion status and outcome. Statistical analysis was conducted with SPSS 15.0. Results: 132 patients (54 NT, 78 ET) were enrolled in the study. On ICU admission, overall mean Hb level was 9.2 g% (95%CI 8.72-9.72) with a significant difference between NT and ET group (10.1 g% versus 8.5 g%; p<0.01). By the day 7 there was little change in overall mean Hb value (9.1 g%; 95%CI 8.85-9.43) as in NT group the Hb values continued to drop while in ET group raised as a result of transfusions. However, at two weeks after ICU admission there was a significant decrease in mean Hb value, from 9.2 g% in day 1 to 8.1 g% (95%CI 7.71-8.49) in day 14. The variance also had a significant decrease over time (8.94 in day 1; 1.58 in day 14) indicating a convergence of Hb values in studied patients, regardless of their transfusion status. Conclusions: Despite the fact that Hb values on ICU admission may vary widely, after 14 days of ICU stay the Hb values tend to converge. The Hb level in critically ill patients with long ICU stays decreases stadly over time no matter the transfused or non-transfused status.

Introduction: Diagnostic or therapeutic bronchoscopy may be performed under general anaesthesia in special circumstances aiming for patient safety and operator comfort. Tracheobronchial instrumentation requires an open system ventilatory support. We report the first case series of oncologic patients managed with Total Intravenous Anaesthesia-Target Controlled Infusion (TIVA-TCI) and Superimposed High-Frequency Jet Ventilation (SHFJV) during flexible and rigid bronchoscopy in our institution. We evaluated the safety profile of this technique in cancer patients. Methods: We analysed 24 oncological patients requiring bronchoscopy under general anaesthesia during a 9 months period. The anaesthetic protocol consisted in TIVA-TCI with propofol, Schnider model, site effect concentration, with standard intra-anaesthetic monitoring plus hypnosis and neuromuscular function monitoring and SHFJV using Twin Stream TM ventilator. Results: A number of 25

SUMMARY The aim of the study was to outline technical difficulties and procedural complications of using partially covered esophageal self-expandable metal stents (SEMSs) in malignant esophageal respiratory fistulas (ERFs) as a palliative treatment option. In this study, 150 patients with malignant dysphagia underwent treatment with SEMSs. A total of 36 ERFs were detected through endoscopic or clinical assessment. Complete fistula sealing with SEMSs was possible in 35 of the 36 patients. The majority of fistulas were diagnosed in male patients with advanced esophageal cancer. All of them presented with prolonged dysphagia and cachexia. Stent migration or tumoral overgrowth was identified in 6 cases with recurrent dysphagia, and required a second stent insertion. SEMSs were highly efficient in 98% of the patients studied with ERFs, with successfully sealed ERFs after the first attempt, with an overall median survival rate of 92 days. The technique of esophageal SEMS placement is simple and can be rapidly mastered. Patients with ERFs have a respiratory shunt that makes intubation difficult and is often avoided. Restoring oral feeding increased the patient quality of life. SEMS placement is generally safe, but has few associated postoperative complications.