Cytoreductive Surgery: Overview

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Cytoreductive surgery is a procedure to remove cancer that has spread to the peritoneal (abdominal) cavity. It is performed on patients with peritoneal carcinomatosis (cancer that has spread within the abdominal cavity) to remove all visible signs of cancer.

Cytoreductive surgery and hyperthermic (heated) intraperitoneal chemotherapy (HIPEC) are two separate procedures that are usually performed together. Cytoreductive surgery removes all visible cancer cells, and HIPEC targets any remaining microscopic cells. HIPEC is administered in the operating room typically after cytoreductive surgery.

This article explains cytoreductive surgery, how it is performed, the risks, and what to expect before, during, and after surgery.

Surgeon and patient

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What Is the Peritoneal Cavity?

The peritoneal cavity is the space between the two layers of the peritoneum, a thin membrane that lines the abdominal cavity. The peritoneum protects and supports organs in the abdomen and pelvis, including the stomach, intestines, and liver.

What Is Cytoreductive Surgery?

Cytoreductive surgery is a scheduled inpatient procedure only performed on patients with advanced cancer that has spread to the abdomen.

The most common cancers that need this type of surgery include:

The procedure is performed while patients are under general anesthesia using a median laparotomy, or long incision, down the middle of the abdomen. After making the incision, a surgeon will thoroughly examine the peritoneum and remove any sections with visible cancerous tumors using electrosurgery (cutting using electrical currents). This is called a peritonectomy.

What Is Electrosurgery?

Electrosurgery uses a high-voltage electrical current delivered through a ball-tipped instrument to cut or remove tissue. Instead of using scalpels, electrosurgery helps control blood loss and prevent tumor cells from spreading through the abdomen during surgery.

Surgeons may also need to remove part or all of the nearby organs and tissues during cytoreductive surgery to get to and remove all the cancer present. If necessary, surgeons will also perform reconstructive procedures on abdominal organs to function normally. Tubes and drains may be placed in the abdomen for postoperative chemotherapy and to prevent fluid from accumulating.

Other Surgical Techniques

Laparoscopic surgery—making small incisions through which a small rod with a lighted camera and instruments can be inserted—is sometimes used in patients with limited disease. Research has shown the laparoscopic approach to be safe and offer good outcomes in these patients. The minimally invasive procedure typically requires shorter hospital stays and has faster recovery times than traditional surgery.

Who Gets Cytoreductive Surgery?

The medical team carefully chooses patients undergoing cytoreductive surgery to ensure they are good candidates. Candidates for cytoreductive surgery are selected based on who will benefit the most with the least risk. Choosing the right patient is key to the surgery’s success.

Cytoreductive surgery is a complicated surgery that should only be performed by highly skilled, experienced surgeons on patients who have been carefully selected for the procedure.

Potential Risks

Risks of cytoreductive surgery include:

  • Fatigue as the body recovers
  • Nausea and loss of appetite
  • Hair loss from lack of nutrition
  • Bowel problems
  • ​Other risks (depending on the degree of organ removal necessary)

Purpose of Cytoreductive Surgery

Cytoreductive surgery is performed on cancer patients whose cancer has spread to their abdomen. Its purpose is to provide relief of symptoms and improve a patient's prognosis and quality of life. The surgery has improved survival rates for cancers once considered inoperable, including peritoneal mesothelioma.

How to Prepare

Typically, people are admitted to the hospital on the day of their surgery, while others may be admitted the day before. Preoperative testing, including X-rays and blood tests, may be done any time in the month leading up to your surgery.

Your healthcare provider will discuss instructions on when to stop eating and drinking and if you need to stop taking medications before surgery. Make sure you discuss any medications you are taking with your healthcare provider before your procedure.

Since cytoreductive surgery requires an extended hospital stay after surgery, you should bring pajamas, slippers, a robe, and anything else to make your stay more comfortable.

What to Expect on the Day of Surgery

On the day of your surgery, you will be taken to a preoperative area, where an IV (intravenous line) will be placed in a vein so you can receive medications and fluids during surgery. You also may receive medications to help you relax. Your surgeon and anesthesiologist will visit you before surgery to talk to you and answer any last-minute questions you might have.

You’ll be wheeled on your bed into the operating room when it’s time for your surgery. Once in the operating room, you’ll be taken off your stretcher and placed in a bed. You will be hooked up to machines that will let your surgical team monitor your blood pressure, heart rate, and oxygen
levels during surgery.

You’ll receive general anesthesia through an IV and possibly through a mask worn over your nose and mouth. A breathing tube is usually placed in your windpipe to help you breathe during surgery. You will not be awake or feel any pain during the procedure.

How long cytoreductive surgery takes depends on the following:

  • How advanced the cancer is
  • What organs are involved
  • If there is any damage to organs from previous surgeries

The HIPEC portion of the procedure ranges from one to two hours. The entire process—including examining the peritoneum and abdomen for signs of cancer, removal of tumors, and HIPEC delivery—varies from four to 10 hours.

Recovery

Recovery from cytoreductive surgery typically requires a hospital stay of five to seven days, depending on the surgery's extent and the patient's overall health and age. Some patients may need to stay in the hospital for up to two weeks.

After surgery, you may have a tube placed to drain your stomach until bowel function returns to normal. You'll likely receive medications through your IV that will help manage pain or nausea. You will gradually go from liquid to solid foods and then have small, frequent meals. Any temporary hair loss should also improve with proper nutrition.

Before being discharged from the hospital, you should be able to move around, eat, and get your pain under control with oral medications. Most patients can return to work one month after the surgery and must avoid heavy lifting for at least six weeks after the procedure. It may take up to two or three months until you can go back to normal activities after surgery.

Your healthcare provider will review any changes to your diet, activity levels, and lifestyle that will help you get the most benefit from the surgery.

Long-Term Care

Cytoreductive surgery can have complications such as problems with wound healing and digestive issues that may require long-term care. However, cytoreductive surgery is associated with lower morbidity (medical issues caused by treatment) than similar advanced cancer surgeries.

You will continue to need to see your medical team for follow-ups regarding your cancer treatment.

Summary

Cytoreductive surgery is used in patients whose cancer has spread to the abdominal cavity. During the surgery, surgeons look for and remove cancerous tumors from the peritoneum and nearby organs. Cytoreductive surgery can be performed along with HIPEC. With this combination, healthcare providers can target visible and microscopic tumors. The surgery is complex and should be performed only by surgeons who are highly trained in the procedure on patients who’ve been carefully selected as suitable candidates.

A Word From Verywell

Cytoreductive surgery with HIPEC has improved survival rates and quality of life for many cancer patients who would not have been candidates for surgery in the past. While the procedure was once performed only by a limited number of surgeons on a small selection of patients, it is now being used on a wider basis worldwide.

14 Sources
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