Advanced ovarian cancer surgery (cytoreductive surgery)

Advanced ovarian cancer surgery

Ovarian cancer is a complex and aggressive disease, especially when it advances beyond the ovaries and spreads to other parts of the abdomen or pelvis. Effective treatment often requires a combination of surgery and chemotherapy. At Birmingham Gynaecology Clinic, we specialise in advanced ovarian cancer surgery, including debulking surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). These treatments are essential for improving your outcomes, prolonging survival, and enhancing your quality of life.

 

What is cytoreductive/debulking surgery?

Cytoreductive surgery, also known as, debulking surgery, is a key procedure in treating advanced ovarian cancer. The primary goal of this surgery is to remove as much of the tumour as possible. This might involve removing your ovaries, fallopian tubes, and uterus, as well as any visible cancer that has spread within your abdomen. In some cases, parts of other organs, such as your bowel, spleen, or liver, may need to be removed if they are affected by the cancer.

 

Why is debulking surgery important?

Debulking surgery is vital for managing advanced ovarian cancer because it significantly impacts the effectiveness of your subsequent treatments, particularly chemotherapy. The success of the surgery is measured by how much cancer remains after the procedure. Optimal debulking aims to leave behind no visible tumour or, at most, a tumour no larger than 1 cm in diameter. Achieving this “optimal” status is associated with significantly better survival rates, as smaller residual tumours are more vulnerable to chemotherapy.

 

Benefits of debulking surgery

  • Enhanced chemotherapy effectiveness: Tumours that are reduced in size through debulking surgery respond better to chemotherapy, making it easier to target and destroy the remaining cancer cells.
  • Symptom relief: By removing large portions of the tumour, debulking surgery can help alleviate symptoms caused by the cancer, such as pain and discomfort.
  • Increased survival rates: If you undergo successful debulking surgery, where minimal cancer is left behind, you are likely to have better outcomes and longer survival compared to those who do not have the surgery or have significant residual disease.

 

When is debulking surgery used?

Debulking surgery is often the first line of treatment for many cases of advanced ovarian cancer. It is typically performed alongside chemotherapy, either before or after the surgical procedure, depending on your specific situation. Given that most ovarian cancer patients are diagnosed at an advanced stage, debulking surgery plays an essential role in your overall treatment plan.

 

What to expect during and after the procedure

  • Preparation: Undergoing debulking surgery is a major procedure that requires careful preparation. The surgery is performed under general anaesthesia and may last several hours, depending on the complexity and extent of tumour spread. If chemotherapy is also used, surgery typically takes six to 12 hours.
  • During the procedure: After surgery, you may have a drain in your abdomen to remove any fluid, which is usually removed within a couple of days.
  • Recovery: You will typically stay in the hospital for 7 to 14 days, including a period of intensive care to monitor your recovery and manage any complications. After surgery, it may take a few weeks or months to return to your normal activities, and complete recovery may take anywhere from two to three months. Recovery can be challenging, and you may experience postoperative pain, fatigue, and temporary changes in bowel function. It is important to tell your gynaecologist about any pain or other symptoms during this time. You may be prescribed medication to manage pain and advised on how to control other symptoms.
  • Follow-up: Regular follow-up appointments are essential to monitor your recovery, address any complications, and plan further treatment if needed.

 

Removing part of the bowel

If the cancer has spread to your bowel, it may be necessary to remove a section of the bowel. In such cases, the surgeon will remove the affected portion and, if possible, join the two remaining ends together, a procedure known as a bowel re-join. However, if the remaining sections of the bowel cannot be safely joined, the surgeon may bring the upper end of the bowel out onto the surface of your abdomen to create a stoma. A stoma allows waste to exit your body into a special bag worn over the opening. A stoma can be temporary, to protect a bowel re-join, or permanent if a safe re-join is not feasible. If you are likely to need part of your bowel removed, your gynaecologist will discuss this with you before your operation. If a stoma is required, your hospital team and a stoma nurse will provide you with support and advice.

 

Possible risks

Like any surgery, cytoreduction comes with risks. When treating advanced ovarian cancer, potential complications and side effects include:

  • Pain
  • Excessive bleeding
  • Bladder problems (frequent urination, urinary tract infection, uncontrollable urination)
  • Lymphedema (swelling)
  • Loss of fertility
  • Fertility problems
  • Menopause
  • Blood clots
  • Infection
  • Intestinal blockage

 

If you notice any of the following symptoms after debulking surgery, immediately contact your gynaecologist or seek medical care:

  • Urination difficulties
  • Excessive vaginal bleeding
  • Fever or signs of infection
  • Worsening abdominal pain
  • Pain, redness, or swelling in a leg
  • Shortness of breath, chest pain, or coughing up blood

 

Other effects of debulking

If you are premenopausal and have both ovaries removed during debulking surgery, you will start menopause early. Menopause symptoms include hot flushes and vaginal dryness. Some women find menopausal symptoms very difficult to cope with. If you do, you can talk to your specialist or gynaecology cancer nurse about this. Some women can take hormone replacement therapy (HRT) for the symptoms of early menopause. Your gynaecologist will discuss the possible risks and benefits with you first. Our specialists at Birmingham Menopause Clinic can also help you with menopause symptoms. Removing both ovaries will also result in the loss of fertility, so it’s important to discuss these issues with your doctor before surgery.

 

What happens after surgery

Once you have started to recover, you may be referred to a physiotherapist or another specialist to help you get back to your normal physical activities. For the first couple of years following debulking surgery, you will have regular check-ups with your gynaecologist. Some women experience long-term emotional or physical side effects after debulking surgery and other cancer treatments. Our team can signpost you to support groups and counselling, which may be helpful tools for coping with these issues.

 

Why choose Birmingham Gynaecology Clinic?

Choosing the right care team is critical for the success of your treatment. Evidence suggests that surgeons who are highly experienced in this procedure are more likely to achieve optimal results. At Birmingham Gynaecology Clinic, you will be in the care of well-trained experts, including gynaecological oncologists who specialise in ovarian cancer treatment. Our team takes a multidisciplinary approach to treating advanced ovarian cancer, ensuring you receive personalised care tailored to your unique situation. We are committed to following the latest guidelines and best practices, and we stay at the forefront of ovarian cancer treatment to offer you the most advanced procedures available.

 

Contact us

For more information on debulking surgery or to discuss your treatment options, please contact Birmingham Gynaecology Clinic. Our team of specialists is here to provide you with the highest standard of care and support throughout your treatment journey. Reach out today to schedule your consultation.

 

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