Debulking Surgery for Ovarian Cancer

Surgery is part of the main treatment course for most ovarian cancers. How much surgical removal you need depends on how far your cancer has spread and on your overall health. While ovarian cancer usually starts in the ovaries, it’s often not detected until it has spread to other organs, and a surgeon’s goal in the OR is to remove as much of the tumor as possible from within the abdomen. The medical term for this is “cytoreductive surgery,” or debulking surgery.

“[We do] debulking surgery when we have evidence preoperatively that the cancer may have already spread to other organs,” explains Dr. Amanda Fader, vice chair of gynecologic surgical operations at Johns Hopkins University. “We’re not really doing a staging procedure, because we know that the cancer is at a more advanced stage. [Our goal] is to try to remove all or most all of that visible disease, which sometimes involves a hysterectomy, removal of the ovaries, lymph node biopsies, and may also involve removing bulky tumors in the other parts of the abdomen or pelvis as well.

“Sometimes we’ll need to remove a portion of an organ and then reconstruct it in order to safely remove all of the cancer,” Dr. Fader says. For instance, “if the tumor has spread to a part of the colon, you’ve got a lot of colon in your abdomen, so we can remove part of it and put it back together again. In many cases, a patient will still have fairly normal function with the remaining colon.

“Sometimes we’ll remove the spleen; sometimes there’s a tumor on the liver or the muscle that separates the chest from the abdomen, called the diaphragm. We will do a really comprehensive assessment of the entire abdomen and pelvis. We leave no stone unturned, if you will, to make sure that we’ve removed all of the disease that we can possibly safely remove.”

Data shows that patients whose cancer has been “optimally debulked,” meaning no tumors larger than 1 cm (less than half an inch) are left behind, have a better prognosis than those left with larger tumors after surgery. Also, says Dr. Fader, “chemotherapy, the complement to surgery that many women with ovarian cancer also receive, works much better on smaller or microscopic tumors than on larger masses. So, if we can debulk most or all of those tumors, we’re apt to see a much better response to chemotherapy.”

Debulking surgery is typically an open surgery, which means it’s done through an incision on the abdomen, from the pubic bone to above the belly button. The operation, whether it’s before chemotherapy or after, is extensive, and can take up to seven hours. And though it’s a big procedure, it gives doctors all the exposure they need in order to get all of the cancer out.

For the most part, doctors say, surgery for ovarian cancer is a safe surgery, especially when it’s done with skilled hands and in institutions that know how to care for cancer patients.

Recovery from Ovarian Cancer Surgery

Understandably, many women are concerned about how much pain they will be in after their operation. Though there’s no such thing as painless surgery there are many ways to decrease discomfort. Doctors will often use TAP blocks, a numbing medication to decrease incisional pain.

After surgery, doctors say that generally speaking, pain can usually be managed with non-narcotic medications. “We’re using a lot of different types of medications to improve pain control without doping women up on heavy doses of narcotics, because we know that opioids and narcotics are not only habit-forming, they can also really slow down the gut and cause constipation,” Dr. Fader says. They can make patients feel fuzzy and sleepy, which means they may not be up and walking around as much as doctors would like.

Patients are encouraged to get up and move around as soon as possible after surgery. Though it may be a little difficult at first, it’s been shown that the sooner patients are moving the better they’ll usually feel, and the faster they tend to recover.

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