The primary principle of managing a tumor is to completely remove it. Debulking surgery is a surgical procedure to completely remove an obstructing mass, a tumor and its metastatic (tumor spread to other parts) lesions. In some cases, the metastatic lesions may not be accessible and thus, only the primary tumor is removed by debulking. The procedure is carried out in the following conditions:
The purpose is palliative
Debulking Tumor surgery; Cytoreductive surgery
Debulking surgery is performed in 3 scenarios. First, called Primary Debulking, is surgical removal of a tumor as an initial treatment protocol. Second, Interval debulking surgery, in which the tumor is resected completely followed by chemotherapy sessions. Third, Secondary debulking surgery, where recurrent tumors, metastatic lesions and residual tumors are removed after chemotherapy or radiotherapy for the primary tumor.
The organ with the primary source of tumor is studied and analysed with the help of an MRI, CT scan, PET scan etc. During surgery, the surgeon will aim at removing the tumor or mass as a whole without invading into healthy tissues. Some tumors cannot be removed entirely due to invasion into healthy tissues, unresectable organs or body parts and risk of bleeding out during surgery. In an Atherectomy procedure, where a diseased artery is replaced with a stent, a debulking surgery is first carried out to remove plaques and other masses in the artery and surrounding tissues.
Surgical removal of a tumor or mass is usually followed by chemotherapy or radiotherapy sessions to prevent recurrence or clear out residual tumors.
Fitness tests are carried out before the surgery to rule out possible risks for the surgery. These include blood tests, blood sugar levels, blood pressure, cardiac status, blood type determination, along with other comorbidities tests. Blood bags are procured to help in restoring lost blood during surgery.
Smoking should be completely stopped.
The individual is usually admitted one to two days before the surgery to monitor for any unstable vitals like increased heart rate, blood sugar etc.
Fasting for a minimum of 12 hours before the surgery is required. The part to be operated on is shaved and cleaned.
Any medications taken must be informed to the oncologist and anesthesia specialist.
You will need to stay calm when anesthesia is administered to minimise discomfort.
Surgical (Open type / Minimally invasive)
An initial early follow up for stitch removal is required followed by regular chemotherapy and radiotherapy sessions, as advised. The patient and caretaker are advised to monitor for any signs and symptoms of distress and episodes of dizziness, weakness, black outs etc., and any such events must be brought to the attention of medical staff immediately. Physiotherapy rehabilitation sessions may be started to mobilize the patient and improve activities of daily living.
Pain and swelling: Pain and swelling at the operated site may be experienced, which usually subsides within a few days with rest and medication.
Loss of function of removed organ or tissue: When the bladder or ureter is operated on, one may have reduced function or loss of voluntary urination. Ovarian cancer debulking may lead to loss of fertility, depending on the number of organs removed.
Infection: The operated site may get infected due to reduced immunity and improper hygiene. It can usually be controlled with antibiotics and preventive care.
Tumor recurrence: The tumor cells may regrow and form another mass and spread to other areas called metastasis. This may need chemotherapy and/or additional debulking surgery.
Death: Research has reported some deaths after debulking surgery, which are rare and occur due to comorbidities.
Rehabilitation after a debulking surgery may take up to 6-8 weeks or longer, depending on the pre-operative status of the individual. One is encouraged to walk and sit up more frequently to prevent blood clots and limb swelling. Follow up chemotherapy and/or radiotherapy sessions need complete compliance from the patient and caretaker.