Debulking Surgery for Ovarian Cancer: What to Expect
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/ Updated May 8th, 2024

Debulking Surgery for Ovarian Cancer: What to Expect

Medical Source: Dr. Adam ElNaggar
West Cancer Center
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Debulking Surgery for Ovarian Cancer

  • The goal of an ovarian cancer debulking surgery is to remove all visible evidence of the disease
  • Primary debulking is when surgery is the first treatment
  • After surgery, most women will get chemotherapy to target any remaining cells
While the steps in treating ovarian cancer are tailored to fit everyone’s unique disease characteristics, most patients will undergo surgery at some point during the course of their treatment. The only difference is at what point during treatment does the surgery take place –before or after chemotherapy. Debulking surgery is a procedure that aims to remove as much of the cancer as possible, with the goal of improving your overall outcome.

"Many women with newly diagnosed ovarian cancer will be offered a primary debulking surgery," says Dr. Adam ElNaggar, gynecologic oncologist at the West Cancer Center in Memphis, Tennessee. "That is the initial step towards treating the ovarian cancer." Primary debulking surgery is when the surgery is given as the first treatment after an ovarian cancer diagnosis. The most common alternative is neoadjuvant chemotherapy, in which the first treatment is instead chemotherapy.

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The decision of whether to have primary debulking surgery or neoadjuvant chemotherapy differs from patient to patient, but your doctor may recommend surgery if your cancer has already spread significantly and progressed to the more advanced stages by the time you are diagnosed. On the other hand, neoadjuvant chemotherapy might be preferred for women who are older, or for those who have other health conditions that may put them at a higher risk for complications from surgery. For these patients, chemotherapy can first shrink the tumor to make it easier to remove during a later debulking surgery.

What Happens During Debulking Surgery?

Debulking surgery is performed by your GYN or surgical oncologist, who operates directly within the body to physically remove the cancer. According to Dr. ElNaggar, open surgery, versus a minimally invasive approache, usually involves making a vertical incision down the middle of the belly, “with the goal of removing all the disease that can be seen with the naked eye."

The cancer is removed from anywhere that it’s visible in the abdomen. "That will of course include the uterus, the cervix, the fallopian tubes, the ovaries," says Dr. ElNaggar. Other areas might also be affected, including the lymph nodes, the omentum (a "fatty apron" that hangs over the stomach), the spleen, and the gallbladder.

Surgery may also include a bowel resection if the cancer has spread to the small or large intestine. A bowel resection involves removing and then reconnecting part of the intestine, after which you may need to have an ostomy bag to collect waste until your bowel heals.

What Happens After Debulking Surgery?

After the surgery is complete, you will be placed into one of three categories, depending on how much of the cancerous tissue was successfully removed. The three categories are:

  • Suboptimal cytoreductive surgery: You still have tumors larger than 1 centimeter in the abdomen
  • Optimal surgery: Any disease that is left in the abdomen measures less than 1 centimeter
  • No gross residual disease: No disease can be seen in the abdomen

Patients with optimal surgery or no residual disease tend to have a better prognosis following surgery than those who have more cancer left behind. However, even if you are categorized as "optimal" or "no gross residual disease," this does not mean that the cancer is completely gone. "It takes about a million cancer cells to be the size of a tip of a pen," says Dr. ElNaggar. "So while I can't see any cancer, we know that it's there, and therefore the next step to curative therapy is to give chemotherapy after the surgery."

Recovery from Ovarian Cancer Surgery

Understandably, many women are concerned about how much pain they will be in after their operation. Though there's no such thing as painless surgery there are many ways to decrease discomfort. Doctors will often use TAP blocks, a numbing medication to decrease incisional pain.

Patients are encouraged to get up and move around as soon as possible after surgery. Though it may be a little difficult at first, it's been shown that the sooner patients are moving the better they'll usually feel, and the faster they tend to recover.

After primary debulking surgery, most patients will go on to have chemotherapy to get rid of any cancer cells that remain in the abdomen. Combining surgery with chemotherapy gives your doctor the best chance of getting as much of your cancer as possible, which could ultimately help improve your outcome.

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Dr. Adam ElNaggar is an assistant professor of gynecologic oncology at the University of Tennessee Health Science Center (UTHSC), and director of gynecologic cancer research at the West Cancer Center in Memphis, Tennessee. His clinical interests include personalized medicine, advanced surgical techniques, and targeted therapies. Read More

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