Patients with malignancies scheduled for elective surgery will be enrolled after providing informed written consent. Patients fulfilling the inclusion criteria will be identified during surgical assessment, and baseline data, including demographic details (age, gender, BMI, and socioeconomic status), cancer type, stage, prior treatments (radiotherapy or chemotherapy), and comorbidities, will be documented. Preoperative laboratory investigations will include a complete blood count, iron studies (serum ferritin, transferrin saturation, serum iron, and total iron-binding capacity), and renal and liver function tests to exclude secondary causes of anemia. 4ml of blood will be drawn in excess to routine investigations for research purpose. To differentiate absolute iron deficiency anemia (IDA) from functional iron deficiency due to inflammation (anemia of chronic disease), absolute IDA will be defined as serum ferritin <30 ng/mL and transferrin saturation (TSAT) <20%, while functional iron deficiency will be considered when ferritin is 30–100 ng/mL with TSAT <20%. The reports of the iron studies will be shared with the treating surgeon, and the treatment, if provided, will be recorded. A preoperative quality of life (QoL) assessment using FACT-An will be conducted.

During the perioperative period, all patients will undergo elective oncologic surgery following standardized surgical and anesthetic protocols, and intraoperative parameters such as blood loss, transfusion requirements, hemodynamic instability (requirement of continuous infusion of inotropes and/or vasopressor support in the intraoperative period), complications, and operating time will be recorded. Postoperatively, patients will be monitored for complications like surgical site infections, anastomotic leak, and acute kidney injury. Need for blood transfusion, duration of hospital stay and any readmission following discharge (within 30 days) will be recorded. QoL will be reassessed before discharge using the same validated questionnaire (Fact-An Questionnaire) to evaluate early postoperative recovery.