cytoreductive surgeryJoe Segen2016-11-23T12:06:08+00:00
Definition Surgery intended to reduce the mass effect of a malignancy by removing a significant portion of the lesion, recognising that complete removal is impossible.
Raisons d’etre for debulking:
(1) Reduce tumour load/bulk
(2) Oxygenate tissues-malignant cells often survive well in low O2 environments; O2 may be toxic to them
(3) Allow the malignant cells space to freely proliferate, at which time they become susceptible to chemotherapeutic agents that act optimally at various steps in the cell growth cycle–e.g., only 10% of the cells in larger tumour masses are actively proliferating; quiescent cells are not susceptible to chemotherapy.
In gynaecologic oncology, debulking is performed for extensive metastatic ovarian cancer, a tumour in which implants may virtually cover the peritoneum
Pros Better growth rate of small tumours after DS, meaning that more cells will be in susceptible part of growth cycle; removal of large tumours reduces the risk that drug-resistant clones will appear due to spontaneous mutation. Debulking procedure typically excise all tumour implants > 1.0 cm in diameter, followed by radiation and chemotherapy, after which, if the tumour has melted sufficiently, a 2nd, hopefully definitive, operation can be performed. Such a combined modality approach yields a 50% 5-year survival. Cytoreduction significantly increases the length of progression-free and overall survival (after adjusting for various prognostic factors, the risk of death is decreased by one third). The patient is then followed by serial measurements of CA-125, a serum marker for recurrent malignancy.
Debulking has been used for aggressive high-grade lymphomas, mesotheliomas, colorectal cancer and melanomas.
Synonyms Debulking operation, debulking surgery