Definition
Cytoreductive surgery is a surgical procedure aimed at removing as much tumor burden as possible, typically used in advanced-stage ovarian, fallopian tube, or peritoneal cancers (including high-grade serous carcinoma).
- Also called debulking surgery.
- Goal: “no gross residual disease” (optimal cytoreduction).
Indications
- Advanced epithelial ovarian cancer (FIGO stage III–IV).
- Peritoneal carcinomatosis from other primary tumors in selected cases.
- Typically performed before or after chemotherapy depending on patient fitness and disease burden:
- Primary cytoreduction: before chemotherapy.
- Interval cytoreduction: after neoadjuvant chemotherapy (NAC) if initial disease is unresectable.
Types of Cytoreduction
- Optimal cytoreduction
- Suboptimal cytoreduction
- Residual tumor nodules >1 cm.
- Associated with poorer prognosis, but surgery may still help symptom control.
Surgical Components
- Oophorectomy / salpingo-oophorectomy
- Hysterectomy
- Omentectomy (removal of omentum)
- Resection of peritoneal implants
- Resection of involved bowel, spleen, diaphragm, liver surfaces if feasible
- Lymphadenectomy (selective, based on spread)
Pharmacy & Perioperative Considerations
- Chemotherapy Timing
- Neoadjuvant chemotherapy (NAC) may be given before surgery to reduce tumor burden.
- Adjuvant chemotherapy usually follows surgery.
- Drug Implications
- Pre/postoperative cytotoxic drugs (e.g., carboplatin, paclitaxel) require careful renal, hepatic, and hematologic monitoring.
- Surgery may affect absorption of oral agents temporarily.
- Supportive Care
- Antiemetics (post-op nausea/vomiting, chemotherapy).
- Thromboprophylaxis (high risk post-op and in ovarian cancer).
- Analgesics and infection prophylaxis (especially if bowel resection performed).
Outcomes
- Complete cytoreduction (no visible disease): best survival outcomes (~50–60% 5-year survival in HGSC if optimal).
- Suboptimal cytoreduction: poorer prognosis, but may still improve quality of life by reducing ascites, pain, or bowel obstruction.