Debulking surgery/cytoreduction

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

Debulking surgery, or cytoreduction, is an operation that decreases the amount of cancer in the body. For many types and stages of cancer, the best surgical method is to remove the entire tumor or all tumors. However, some cancers are too widespread or grow in close quarters with essential organs, making it difficult and overly damaging to remove the cancer completely. The idea of debulking surgery is to safely remove as much cancer as possible. The remaining cancer is usually treated with other therapies, such as radiation or chemotherapy.

Why debulking surgery may be performed

Debulking surgery may be used to relieve symptoms caused by large tumors and to slow the growth of advanced cancers, including some types of lymphoma, brain cancer, endometrial cancer, mesothelioma and other cancers that have spread to the peritoneum (lining of the abdomen).

However, it’s most commonly used alongside chemotherapy as the first line of treatment for many ovarian cancers.

Debulking surgery is a mainstay of ovarian cancer treatment because most are diagnosed when they’re more advanced. Compared with other advanced cancers, advanced ovarian cancer tends to respond better to debulking surgery and chemotherapy.

According to the American Cancer Society, about 80 percent of ovarian cancer cases are advanced by the time they’re diagnosed, likely because many patients experience no symptoms or symptoms that may easily be mistaken for other conditions. There are also no widely accepted screening methods for ovarian cancer, meaning that asymptomatic women are rarely checked for this disease.

The advantage of debulking surgery in advanced cases is that it leaves behind small amounts of cancer in the body, which may be more easily reached and destroyed by chemotherapy. Tumors that are “debulked,” or made smaller, are more vulnerable to chemotherapy. The goal of debulking surgery is to leave behind as little cancer as possible.

How to prepare for debulking surgery

To prepare for debulking surgery or any cancer surgery, it’s essential that you’re fully informed of the procedure and its potential benefits and risks. Consider writing down a list of questions and going over them with your care team.

Make sure that your surgeon has significant experience performing this procedure. For example, debulking surgery for ovarian cancer should be performed by a gynecologic oncologist—a doctor who specializes in cancers of the female reproductive system.

If you’re undergoing debulking surgery for ovarian cancer and are interested in retaining your ability to have children, it’s important to communicate that to your care team, as both ovaries may be removed during surgery.

Before your surgery date, your care team may provide more detailed instructions on how to prepare.

If you smoke, it’s recommended that you quit for as long as you can. Smoking makes it harder for your body to heal because it affects blood flow. Smokers also face higher risks of surgical complications.

Tell your care team about any and all medications and supplements you take.

You may have to stop taking certain medications for some time before surgery. You may be advised not to eat or drink starting at midnight the night before surgery.

What to expect from debulking surgery

Before a debulking surgery, you’ll likely be given general anesthesia through an intravenous (IV) line to ensure that you’re in a deep sleep during the procedure and unable to feel pain.

The operation varies widely depending on the type and stage of the cancer. Some debulking surgeries may be minimally invasive and only require small incisions (laparoscopic), while others require open surgery using one large incision to gain direct access to the abdomen.

In general, debulking surgery is used on cancer that has spread widely in the abdomen, and it aims to take out all visible tumors. However, which abdominal areas or organs are removed depends on the extent and type of cancer.

For example, debulking surgery for ovarian cancer may include full or partial removal of the following organs and tissues:

  • Uterus and cervix
  • One or both ovaries
  • One or both fallopian tubes
  • Omentum (fatty tissue lining the lower abdomen)
  • Spleen
  • Gallbladder
  • Stomach
  • Liver
  • Pancreas
  • Small intestine
  • Colon
  • Bladder

At the end, if the surgery doesn’t leave behind any visible cancer or tumors bigger than 1 cm, the cancer is considered “optimally debulked.” If the surgeon was unable to optimally debulk the tumors, and more cancer is left in the body, the tumors are considered sub-optimally debulked, and they tend to have a poorer outlook.

If part of the colon is removed, the surgeon either reattaches the two remaining ends of the colon back together or sews the top end to an opening in the abdomen. If the colon is attached to an abdominal opening (stoma), your waste needs to exit through this opening into a colostomy bag for some time. Usually, if the surgeon is unable to reconnect the surviving colon pieces during the initial surgery, a later surgery is scheduled to do so, and the use of a colostomy bag is only temporary. Similarly, if part of the small intestine or bladder is removed, temporary fixes such as an ileostomy bag to evacuate waste from the small intestine or a catheter to clear urine from the bladder may be necessary.

In some cases, chemotherapy may be delivered directly into the abdomen after debulking. Called intraperitoneal chemotherapy, this procedure involves injecting a concentrated dose of chemotherapy drugs into the abdomen.

If performed with chemotherapy, the debulking surgery may take six to 12 hours to complete.

When you awake from surgery, you may have a tube in your abdomen to get rid of any fluid, but this is usually removed within a couple of days.

The length of your hospital stay depends on the type of surgery you require. Ovarian cancer patients may need to remain in the hospital for three to seven days, for example, while patients who undergo debulking surgery with chemotherapy may have a longer stay. Complete recovery may take anywhere from one to three months.

Benefits, risks and results

When debulking surgery is used in combination with chemotherapy delivered directly to the abdominal cavity, the potential benefits may include:

  • Better quality of life
  • Increased survival time
  • Symptom relief
  • Lower chances of recurrence

The benefits are much more pronounced when the cancer is optimally debulked, as opposed to sub-optimally debulked. Evidence suggests that surgeons and care teams who are highly experienced in this procedure are more likely to render optimal results, which is why it’s of the utmost importance to be in the care of well-trained experts.

After surgery, it may take weeks or months to return to your normal activities. It’s important to communicate any pain or other symptoms with your doctor during this time. Your care team may prescribe medication to manage pain and advise you on how to control other symptoms.

Premenopausal women who have both ovaries removed during a debulking surgery will start menopause early. Menopause symptoms include hot flashes and vaginal dryness. Women who have both ovaries removed also lose their ability to have children. Patients need to discuss these issues with their doctor before surgery.

Like any surgery, cytoreduction comes with risks. When treating advanced ovarian cancer, for example, potential complications and side effects include:

  • Pain
  • Excessive bleeding
  • Bladder problems (frequent urination, urinary tract infection, uncontrollable urination)
  • Lymphedema (swelling)
  • Loss of fertility
  • Fertility problems
  • Menopause
  • Blood clots
  • Infection
  • Intestinal blockage

Throughout the recovery process, it’s important to keep in close contact with your care team. If you notice any of the following symptoms after debulking surgery, immediately call your care team or seek other medical care:

  • Urination difficulties
  • Excessive vaginal bleeding
  • Fever or signs of infection
  • Worsening abdominal pain
  • Pain, redness or swelling in a leg
  • Shortness of breath, chest pain or bloody cough

Life after debulking surgery

Recovery after debulking surgery and other cancer treatments may be a long road, but there are many resources for support available.

First and foremost, it’s important to lean on your cancer care team, as they can provide advice and direct you to helpful resources. Once you feel better, you may be connected with a physiotherapist or another specialist to help get you back on your feet. For the first couple of years following debulking surgery, you’ll most likely visit your doctor frequently for check-ups.

Some people endure long-term emotional or physical side effects after debulking surgery and other cancer treatments. Support groups and counseling may be helpful tools for coping with these issues.

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