It is normal for anyone to feel a great deal of fear and shock when they learn that they have cancer, especially when they hear that it has spread to other parts of the body. However, in today's advanced medical science, there are powerful treatments that can help extend life and control symptoms even in such cases. Today, we are going to talk about one such special surgery. This is called Debulking surgery.
Simply put, what is Debulking surgery?
Imagine that a garden has a lot of weeds. What do we do? We pull out as many of those weeds as possible, right? Then the good trees and vines have a chance to grow properly again. Debulking surgery, or `(Cytoreduction)` surgery, is something like that.
Simply put, this involves surgically removing as much of the cancer as possible when it has spread throughout the body. Sometimes it may not be possible to completely remove the cancer. But removing as much of it as possible makes it easier for other treatments, such as chemotherapy, to control any remaining cancer cells.
This has several main objectives:
- Helping to extend life expectancy.
- Slowing down the spread of cancer.
- Relieving symptoms such as pressure and pain caused by cancerous tumors on surrounding organs.
- In some cases, this surgery can even help completely cure diseases like ovarian cancer.
What types of conditions is this surgery mainly performed for?
Debulking surgery is most commonly used for cancer that has spread to the abdominal cavity (inside the belly) and pelvis. Doctors may consider this surgery in the following situations:
| Medical condition | A brief introduction |
|---|---|
| Ovarian Cancer | This surgery is most commonly performed when epithelial ovarian cancer, which originates from the cells lining the outer layer of the ovary, has spread. |
| Peritoneal Cancer | It is used for cancers that spread to the peritoneum , the membrane surrounding organs in the abdomen, such as the liver and stomach. |
| Peritoneal Mesothelioma | This surgery is also performed for this cancer condition, which can be caused by factors such as asbestos inhalation. |
| Pseudomyxoma Peritonei | This is a condition where cancer in the appendix spreads mucus throughout the abdomen. Surgery is performed to remove the mucus. |
What happens before the surgery?
Since this is a major surgery, there needs to be good preparation beforehand.
Discussion with the doctor
Your surgical oncologist will explain everything to you clearly.
- Preoperative treatment: Sometimes neoadjuvant therapy, such as chemotherapy, may be given before surgery to shrink the cancer.
- Type of surgery: The doctor will decide whether this will be done as a ``laparoscopic surgery'', meaning a camera is inserted through a few small incisions, or as a ``laparotomy'', meaning the abdomen is opened.
- Organs removed: In cases of ovarian cancer, the ovaries, fallopian tubes, uterus, and cervix are usually removed. Depending on how far the cancer has spread, part of the small intestine or colon may also need to be removed.
- Surgery time: This is a major surgery that takes several hours, but the time may vary depending on your condition.
Required tests
Several tests will be performed to see if your body is suitable for the surgery.
- Blood tests: Blood sugar levels, complete blood count (CBC), kidney and liver function tests.
- Imaging tests: Things like chest X-rays, CT scans, MRI scans, and PET scans may be done.
Meeting with the anesthesiologist
The anesthesiologist will ask you a few questions before anesthesia. For example, they will ask about your previous experience with anesthesia, the medications you are taking, the vitamins you take, any other medical conditions you have, and the condition of your teeth.
How should you prepare for the surgery?
- Avoid smoking: If you use any form of nicotine, including cigarettes and e-cigarettes, stop immediately. Nicotine can interfere with blood flow and delay wound healing after surgery.
- Fasting: You will be advised to refrain from eating or drinking for several hours before surgery. Follow these instructions carefully.
- Plan your hospital stay: You will need to stay in the hospital for a few days (usually 3-7) after this surgery. It will be helpful to have your household and work tasks planned out in advance for that time.
- Someone to help you after you get home: It's great to have someone to help you in the first few days after you get home.
What happens during the surgery?
After you are given anesthesia, you will be completely asleep. You will not feel any pain. The surgeon will make one or more incisions in your abdomen and carefully remove the cancerous tumor and any tissue that has spread. In some cases, a special treatment called ``Hyperthermic Intraperitoneal Chemotherapy (HIPEC)``, in which heated chemotherapy drugs are injected into the abdominal cavity during surgery, may be done. Finally, the incisions will be sewn up, and a tube ``drain`` may be placed to drain any fluid that has accumulated inside your body.
What happens after the surgery?
You will be monitored by medical staff in a recovery room until you wake up from the anesthesia. During the few days you will be in the hospital, they will give you pain medication, clean your wound, etc. They will first give you small amounts of water to drink, and then they will introduce you to liquid foods.
Important: You will be taught some special exercises at the hospital. Leg exercises help prevent blood clots (deep vein thrombosis). Deep breathing and coughing help clear the lungs and reduce the risk of infections like pneumonia. These are essential.
What are the side effects and possible complications?
Like any major surgery, this one can have side effects and complications.
- Common side effects: bleeding from the wound, extreme fatigue, loss of appetite, pain, and difficulty defecating.
- Possible complications: blood clots, wound infection, lymphedema, and temporary ileus.
There is no need to be afraid because the medical staff is always attentive to these kinds of things.
How long does it take to recover?
It may take several months to fully recover. It is normal to feel more tired than usual after surgery. Your body uses a lot of energy to heal. So get plenty of rest. You should avoid lifting anything heavier than 4-5 kilograms after surgery. Your doctor will tell you how long you should stay off of it.
When should you seek immediate medical advice?
If you experience the following symptoms after returning home, you should take immediate action .
| Emergency - go to the ETU immediately! | |
|---|---|
| Blood Clot Symptoms | - Difficulty breathing - Coughing with blood - Pain in the chest or upper back - Swelling, redness, or warmth to the touch in one leg |
| Call your doctor immediately. | |
| Infection Symptoms | - The trembling of the body, the feeling of being wet and cold. - Fever (greater than 38 degrees Celsius / 100.4 Fahrenheit) |
Remember, a blood clot in the leg (deep vein thrombosis) can break away and become lodged in a vein in the lungs (pulmonary embolism). This is a life-threatening emergency. So be very aware of these symptoms.
Take-Home Message
- Debulking surgery is a major surgery that removes as much of the cancer as possible that has spread throughout the body.
- This can control symptoms, prolong survival, and increase the success of other cancer treatments.
- Since this is a major surgery, it will take several months to recover. It is normal to feel tired during this time.
- Follow your doctor's instructions carefully after surgery, especially regarding exercise and avoiding heavy lifting.
- If you develop symptoms of a blood clot or infection, seek medical advice immediately without delay.
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