Debulking Surgery (Cytoreduction Surgery)

What is debulking surgery?

Debulking (cytoreduction) surgery is cancer surgery to remove most or all of a cancerous tumor. It’s a common treatment for epithelial ovarian cancer that’s spread to your belly or pelvis and for cancer in your peritoneum. Often, oncologists combine debulking surgery with cancer treatment(s) done before and after surgery.

Debulking surgery and other treatments will help you live longer. It may cure ovarian cancer. For example, debulking surgery that removes most of the targeted tumors and follow-up cancer treatment can slow down how quickly ovarian cancer may spread.

Just as important, the surgery can ease symptoms that may happen as ovarian cancer affects nearby organs. Researchers are studying how combining this surgery with different anticancer drugs may make the treatment more effective.

What other conditions are treated with debulking surgery?

You may have debulking surgery if you have:

• Other types of ovarian cancer. This includes germ cell and stromal cell ovarian cancer
• Primary peritoneal cancer. This is a rare cancer that forms in your peritoneum, the membrane that wraps around organs in your abdomen like your stomach, liver and spleen. Medical experts consider this a type of epithelial ovarian cancer.
• Peritoneal mesothelioma. You may develop this disease after asbestos exposure. It often doesn’t cause symptoms until it spreads from your peritoneum to your stomach or other organs in your abdomen.
• Pseudomyxoma peritonei. This cancer starts as a polyp in your appendix. Cancer cells in your appendix produce so much mucin that your appendix bursts, spreading the mucin throughout your peritoneum. Mucin is the main component of mucus. Debulking surgery removes as much mucin as possible.

What happens before debulking surgery?

You may have neoadjuvant therapy. This is cancer treatment before surgery to shrink tumors. Before you have the procedure, your surgical oncologist will explain:

• Whether they’ll do laparoscopic surgery (minimally invasive surgery) or laparotomy (open abdominal surgery)
• What surgery will entail — for example, most ovarian cancer surgery involves removing your ovaries, fallopian tubes, uterus and cervix, But it can include removing part or all your small intestine or colon
• How much time debulking surgery may take in your situation — debulking surgery is major surgery that may take several hours to complete, but the exact amount of time will depend on how much cancer your surgeon plans on removing.
• What kind of support you’ll need as you continue recovering at home.

They may order presurgery tests to confirm you’re able to have debulking surgery. Tests may include an electrocardiogram to check your heart health, blood tests, imaging tests and more.

Blood tests

You may have the following blood tests:

• Blood glucose (sugar) test. Like the name suggests, this test checks on the level of sugar (glucose) in your blood.
• Complete blood count (CBC). A CBC checks your white blood cells, red blood cells and platelets.
• Kidney function. This test checks how well your kidneys clear waste from your system.
• Liver function. This test measures different substances in your liver.

Imaging tests

Your surgeon may order imaging tests like:

• Chest X-ray
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI) scan
• Pelvic ultrasound
• Positron emission tomography (PET) scan

Preparing for anesthesia

Your anesthesiologist will meet with you before surgery. They’ll ask about:

• Your previous experience with general anesthesia
• If you take any herbal supplements, medication or vitamins
• If you use other drugs, nicotine or alcohol
• If you have any implants in your body like a breast implant
• If you have loose teeth or have a dental bridge

You may receive anesthesia through a face mask or a tube in your windpipe. In that case, your anesthesiologist will take special steps to protect your teeth.

How should I prepare for debulking surgery?

There are some things you should do to get ready for surgery, including:

• Stop using nicotine. Nicotine in any form, including e-cigarettes, affects your blood flow and makes it hard for you to heal after surgery.
• Fast immediately before. For example, your surgeon may say you can’t eat anything for at least six hours before surgery. You may be able to drink clear liquids for a certain amount of time before surgery.
• Plan for your hospital stay. Debulking surgery is a major operation. You’ll probably be in the hospital for three to four days. Making plans for others to manage your work and home responsibilities means you can focus on healing.
• Plan for help at home. You may want to have someone stay with you for the first few days at home. Consider asking family and friends to help with meals.

What happens during debulking surgery?

Your anesthesiologist will give you medication that puts you into a deep sleep. You won’t feel any pain or be aware of what’s happening.

Your surgeon will make a cut or cuts in your abdomen.

1. If you’re having debulking surgery for ovarian cancer, they’ll remove your reproductive organs. If there’s cancer in nearby organs, they’ll remove as much cancer as they can without damaging those organs.
2. Your procedure may include hyperthermic intraperitoneal chemotherapy (HIPEC), which is heated chemotherapy that your surgeon places in your abdominal cavity.

They’ll close the incisions and may leave a drain in the abdomen to drain fluid.

What happens after debulking surgery?

You’ll be in a recovery room until you wake up from anesthesia. Your care team will keep an eye on your vital signs. If you have pain, they’ll provide pain medication as prescribed by your surgeon.

What happens before I return home?

You’ll probably need to stay in the hospital for two to seven days. During that time, your care team will:

• Take care of your surgery site
• Provide medication to help with pain
• At first, give you sips of water until you’re able to drink more fluids (you may have high-protein liquid drinks before you start eating food)
• Guide you through leg exercises to reduce the risk that you’ll develop a blood clot in your leg (deep vein thrombosis) — a blood clot in your leg can travel through your bloodstream and get stuck in your lungs (pulmonary embolism)
• Demonstrate deep breathing exercises, as deep breathing and coughing will help clear your lungs and lower your risk of pneumonia

What are debulking surgery side effects?

Your surgeon and your care team will explain potential surgery side effects, how they’ll help you to manage them and how you can help yourself. Common side effects include:

• Bleeding from the surgery site or your vagina
• Fatigue
• Loss of appetite
• Pain
• Slowed bowel function that affects your ability to poop

What are the benefits of debulking surgery?

Debulking surgery that removes all signs of cancer may prolong your time without cancer or help cure it. The surgery can keep metastatic ovarian cancer from spreading further. The surgery may also take care of issues that ovarian cancer may cause, like severe constipation from a tumor blocking your bowels.

What are the success rates for debulking surgery?

Research shows surgeons achieve optimal debulking 47% of the time. Optimal debulking means either surgery removes all visible tumors or only tumors measuring less than 1 inch (1 centimeter) remain after surgery. That success rate increases to 77% of the time if you receive chemotherapy or radiation therapy before surgery (neoadjuvant therapy).

It’s understandable if you have questions about how effective debulking surgery will be in your situation. Your surgical oncologist is your best resource for that information.

What are the complications of debulking surgery?

Like most major surgeries, complications can happen after debulking surgery. One reason you remain in the hospital after surgery is so your care team can prevent or watch for issues like:

• Blood clots
• Infection
• Lymphedema
• Temporary ileus

What is the recovery time?

It may take a few months for you to completely recover from debulking surgery for ovarian cancer. You may find you get tired more easily than you did before surgery. That’s normal. It takes energy for your body to heal from surgery. You may also feel extra tired if you’re receiving post-surgery chemotherapy.

Debulking surgery is tough on your abdomen and abdominal muscles. It will take time for them to recover. You should avoid lifting anything that weighs more than 10 pounds until your surgeon says it’s safe to do so.

When should I call my healthcare provider?

If you’re recovering from debulking surgery, you should contact your provider if you have:

• Blood clot symptoms. A blood clot in your leg or your lungs is a medical emergency. Call 911 or your local emergency service number or go to an emergency room if you’re short of breath, cough up blood, have pain in your upper back or your leg is swollen or warm to your touch.
• Infection symptoms. Contact your healthcare provider if you have chills that make you shiver or a temperature of 100.4 degrees Fahrenheit (38 degrees Celsius).

Is debulking surgery the same as hysterectomy?

No, it’s not. Debulking surgery is treatment when ovarian cancer spreads to nearby areas of your body. Your surgical oncologist may do a hysterectomy if you have ovarian cancer that’s not spreading.

In a hysterectomy, your surgeon will remove your reproductive organs, including your uterus. They may also remove your cervix, ovaries and fallopian tubes (total hysterectomy with bilateral salpingo-oophorectomy).