Debulking ovarian surgery, also known as cytoreductive surgery, is surgery to reduce the mass of tumors from advanced stage ovarian cancer. During the procedure, as much cancer tissue is removed as possible, and the rest of the abdomen is surveyed to help orient the future treatment plan. Tumor tissue may be analyzed to address cancer metastasis and also orient the future treatment plan. Debulking ovarian surgery can be performed laparoscopically, using a small camera device that results in minimally invasive surgery, or is performed using traditional surgical techniques.
Typically, debulking ovarian surgery will result in removal of one or both ovaries, the uterus, the cervix, and the fallopian tubes. The surgeon may also remove part of your colon, or remove tumor tissue from other areas of the abdomen. This may result in needing to use a colostomy bag to excrete waste. Most of the time, this is temporary until another procedure can be performed to connect the rest of the colon to the anus. Other parts that may be removed include the bladder (requiring temporary catheter insertion), as well as the spleen, gallbladder, or parts of the stomach, liver, and/or pancreas.
Who is a candidate?
Patients who have been newly diagnosed with advanced stage ovarian cancer who have consulted with an oncologist that has determined that debulking surgery should be part of the treatment plan are candidates for debulking surgery.
Who is not a candidate?
For some patients who have newly diagnosed ovarian cancer, chemotherapy or other types of surgery such as a complete hysterectomy are more appropriate than debulking.
After deciding on a surgical method to treat ovarian cancer, you should have a pre-operative health/risk assessment. Any nonprescription drugs such as aspirin and other pain relievers should be discontinued 7 days before the procedure to reduce the risk of bleeding. If you can, quit smoking, as this will also reduce the risk of bleeding. Review informed consent guidelines with your physician, including fertility outcomes after surgery, decisions to remove the fallopian tubes (salpingectomy) or the ovaries (oophorectomy), and sexual function outcomes after surgery. A week or two prior to ovarian debulking, you will have a battery of tests and X-rays to ensure you are physically fit for surgery. During this time you will be able to ask questions about the procedure, postoperative care instructions and the potential outcomes.
Your doctor will likely have you stop eating and drinking the night before the surgery. One or more enemas are typically given the night before and the morning of the procedure. Immediately prior to the procedure and going underneath general anaesthesia, prophylactic antibiotics are used to prevent infection. You may be sedated prior to going under general anesthesia.
After the procedure, you will likely stay in the hospital for 3 to 10 days. You may have a temporary urinary catheter inserted, depending on if your surgeon needed to operate on your bladder during the debulking surgery. You will be given pain relievers intravenously and likely may have issues with defacation. After you are discharged and cleared to go home, you should rest and refrain from vigorous exercise or vaginal sexual activity until given further instructions by your surgeon. Pelvic floor exercises may be required for the initial recovery period, and possibly for the rest of your life. Patients are encouraged to walk to reduce the risk of blood clots in the legs.
During this time, bleeding from the vagina is expected. However, during the first few (up to 6) weeks, patients should not use tampons or put anything into the vagina, including douching or engaging in sexual intercourse. Sanitary napkins and pads are fine. A follow-up with the physician should help you assess when it is okay to return to work and resume sexual activity. Typically, patients take 6-8 weeks off, or longer, if debulking is performed in combination with chemotherapy.
As with any surgery, there are risks of complications related to infection or adverse reactions to anesthesia. Infection is the minor complication with the highest prevalence in hysterectomies. A proper assessment of every patient, along with complete lab work, will help to prevent postoperative complications. A postoperative course of antibiotics can reduce the risk of infection. After healing, scars are handled with special treatments to minimize their appearance.
Long term, debulking ovarian surgery may lead to hormonal shifts similar to natural menopause, and sexual function will be changed. For women who have not yet undergone menopause, this will be more severe, and will be accompanied by complete loss of fertility. These may impact long-term quality of life and should be assessed prior to having the procedure done.
Average US cost
$40,000+ (depending on exact surgery and individual case)