Debulking, also known as cytoreduction, is the surgery to remove as much tumor from the patient as possible. "The aim of debulking surgery is to leave behind no tumors larger than 1 cm. This is called optimally debulked. Patients whose tumors have been optimally debulked, have a better outlook than those left with larger tumors after surgery."1 A gynaecological oncologist may strive to remove all tumors that are visible to the naked eye.2
If a laparoscopy was performed to remove an ovarian cyst that was ruptured and was later found to be malignant, a gynaecological oncologist may consider removing tissues from sites that might have been traumatized by the procedure, such as the port site. These tissues might enable tumor cells to seed and later metastasize.
While debulking through surgery is a primary mode of treatment for almost all stages of epithelial ovarian cancer, it is much less so for recurrent cases. For example, in countries where patients receive treatments that are publicly funded, their evidence-based quality of care policy might not prescribe surgery for recurrent ovarian cancer. Exceptions might be granted on a case-by-case basis, or based on some specific guidelines, such as only a few simple cancer lesions identified on scans.
There are on-going researches on whether surgery provides real benefits to recurrent epithelial ovarian cancer patients.3 Studies have come up with criteria for identifying suitable patients for secondary cytoreduction and these criteria might or might not be compatible with one another. Some of these criteria are:
- "Only patients cytoreduced to no visible disease achieved a survival advantage, and the only preoperative factor that could predict surgical success regarding prolonging survival was a CA125 less than 250 U/mL."4
- Patients with a single-site recurrence and a long remission.5
- "Patients who develop gross recurrent or progressive ovarian cancer following cisplatin therapy."6
Debulking is often performed at the same time as staging by a qualified gynaecological oncologist.
Information Specific to OCCC
Unlike other histologic types of epithelial ovarian cancer, fertility-sparing debulking surgery is not recommended even for the early stages where the tumor is confined to one ovary. Patients may consult their gynaecological oncologists about assisted fertility options (e.g., egg freezing,7 in vitro maturation, gestational surrogacy8) if fertility is a consideration.