November 18, 2023
By Angie N Choi, EdD, Author of Whole New Me: Healing From Cancer in Body, Mind, and Spirit
Debulking surgery, also known as cytoreduction or partial resection, is an operation that is done to remove malignant tumors typically seen in more advanced stages of cancer.1 In early stages of cancer, surgical removal of all visible cancer is more likely, but in advanced stages, there is a greater likelihood that partial, not complete, removal will occur. In debulking surgery, the goal is to remove as much cancer as possible with the understanding that completely removing all tumors is not possible due to the advanced nature of the disease or metastasis to other critical organs where surgery would be harmful. Debulking surgery is an intentional approach to leave behind as little residual disease as possible. Although this seems to contradict the main principle of surgery for cancer (to completely remove all tumors), debulking is done to improve survival outcomes for patients. Debulking surgery has improved survival for some cancers such as ovarian, renal cell carcinoma, colorectal, and breast cancers.1 However, other trials for renal cell carcinoma, colorectal, and breast cancers have also indicated positive survival improvements with non-surgical therapies which makes the necessity for debulking surgery less clear.1 In many cases, debulking tumors may be done prior to or after other therapies such as chemotherapy and radiotherapy to optimize treatment plans. In this article, we will review how long debulking surgeries take, survival rates after debulking, length of hospital stay, and length of recovery time for ovarian and brain cancers.
Ovarian Cancer Debulking Surgery
How long does it take?
Debulking surgery to remove tumors takes at least 3 hours or more.2 In cases where patients get chemotherapy (intraperitoneal chemotherapy) during the debulking surgery, the entire process may take from 6-12 hours.3 Many factors determine the length of surgery time such as the number of tumors and how far the cancer has spread to other organs. In my case, I had an early-stage cancer and a huge tumor the size of a cantaloupe on my left ovary. I had to have abdominal surgery to remove the tumor which was completely resected – though spillage occurred during surgery. The entire process took about 3 hours. I wrote about what it was like to have the surgery, the short and long-term effects from surgery, and the recovery process in my book.
What are survival rates after debulking surgery?
According to the National Cancer Institute’s SEER database, approximately 51% of ovarian cancer patients (2013-2019) had a 5-year relative survival rate.4 This means that 51 out of 100 women with ovarian cancer were still alive 5 years after being diagnosed. The majority of ovarian cancers are found in later stages (stages 3 & 4), and many will achieve remission regardless of the type of treatment (surgical debulking or not). However, cancer reoccurs in 80-90% of all cases.5 To get a survival benefit, no more than 1-2 cm of residual disease should be left behind.1,2
It is difficult to estimate survival rates after debulking surgery as datasets on debulking are not publicly available, but there have been trials and other studies that provide information on survival outcomes. In a comparison study, 5-year survival rates were higher for debulking surgery than chemotherapy for advanced ovarian cancer patients.6 Debulking surgery does seem to make a difference for newly-diagnosed, advanced ovarian cancer.5 For those who cannot do surgical debulking due to the advanced stage of the disease or due to contending with multiple diseases, neoadjuvant chemotherapy (therapy delivered before main treatment) along with interval debulking may be a good option.5 Also a second debulking surgery may only be beneficial for a few patients who have been disease-free for a lengthy period and have an isolated relapse.
Other studies have indicated uncertain outcomes for second surgical debulking or interval debulking surgeries.7,8 Results from two phase III trials indicated that if a gynecologic oncologist performed the debulking surgery the first time, there really wasn’t much benefit to have a second debulking surgery, but in cases where the first debulking was not performed by a subspecialist (gynecological oncologist), then another debulking could have some value in survival outcomes.9
How long are you in the hospital?
The average hospital stay for women who had abdominal surgery 4.6 days.10
How long does it take to recover?
Recovery time is about 4-6 weeks.11 In my case, I had abdominal surgery and a total hysterectomy. It took about 8 weeks to recover, but healing was a much longer process that took about 5 months for me to have enough energy to return to work. Long-term effects from surgery can take much longer to heal. Two years after my surgery, nerve damage still had not completely healed.
Brain Cancer Debulking Surgery
How long does it take?
A craniotomy is the most common type of surgery to remove or debulk brain tumors. During a craniotomy, a small section of the skull called the bone flap will be removed to allow access to the tumor.12 A craniotomy and debulking surgery or partial resection may last about 4-6 hours and includes the anesthetic procedure, debulking of the tumor, and biopsy.12,13
What are survival rates after debulking surgery?
According to SEER 18 cancer registries, survival rates for glioblastoma are low with only 5.1% of patients surviving 5 years later.14 Some studies have shown that glioblastoma patients who have had craniotomies and tumor debulking have a longer survival time than those who don’t, but that benefits are limited.15-17 Elderly patients and those with poor preoperative status only have a moderate benefit so the risks and benefits should be taken into account.
How long are you in the hospital?
The median length of hospital stay after brain surgery is 4 days.18
How long does it take to recover?
Recovering from brain tumor surgery depends on several factors and may vary between individuals. These factors include where the tumor was located, the areas of the brain that were affected by the tumor, the procedure used to remove the tumor, and the patient’s age and overall health. The patient’s neurosurgeon will be the best person to estimate the length of recovery after surgery.19
In conclusion, surgical debulking typically occurs during advanced stages when cancer has spread to other organs. Patients should talk with their surgeons and subspecialist oncologists to understand the risks and benefits of debulking. Patients may also ask their oncologists to speak with other patients who have had debulking surgery for their specific stage and cancer.
References
1Hishida T, Masai K, Kaseda K, Asakura K, Asamura H, Debulking surgery for malignant tumors: The current status, evidence and future perspectives, Japan J of Clin Oncol. 2021; 51(9):1349–1362.
2NHS Foundation Trust. Interval Debulking surgery. Available at: https://www.gloshospitals.nhs.uk/your-visit/patient-information-leaflets/interval-debulking-surgery-ids-ovarian-cancer-ghpi1564/. Accessed on November 13, 2023.
3 City of Hope. Debulking surgery (cytoreduction). Available at: https://www.cancercenter.com/treatmentoptions/surgery/debulkingsurgery#:~:text=In%20some%20ovarian%20cancer%20patients,to%2012%20hours%20to%20complete. Accessed on November 13, 2023.
4National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Ovarian Cancer. Available at: https://seer.cancer.gov/statfacts/html/ovary.html. Accessed on November 13, 2023.
5Schorge JO, McCann C, Del Carmen MG. Surgical debulking of ovarian cancer: what difference does it make? Reviews in obstetrics and gynecology. 2010;3(3):111.
6May T, Comeau R, Sun P, Kotsopoulos J, Narod SA, Rosen B, Ghatage P. A comparison of survival outcomes in advanced serous ovarian cancer patients treated with primary debulking surgery versus neoadjuvant chemotherapy. International Journal of Gynecologic Cancer. 2017; 27(4).
7van der Burg ME, van Lent M, Buyse M, Kobierska A, Colombo N, Favalli G, Lacave AJ, Nardi M, Renard J, Pecorelli S. The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. New England Journal of Medicine. 1995 Mar 9;332(10):629-34.
8Rose PG, Nerenstone S, Brady MF, Clarke-Pearson D, Olt G, Rubin SC, Moore DH, Small JM. Secondary surgical cytoreduction for advanced ovarian carcinoma. New England Journal of Medicine. 2004 Dec 9;351(24):2489-97.
9Chi DS, Ramirez PT, Teitcher JB, Mironov S, Sarasohn DM, Iyer RB, et al. Prospective study of the correlation between postoperative computed tomography scan and primary surgeon assessment in patients with advanced ovarian, tubal, and peritoneal carcinoma reported to have undergone primary surgical cytoreduction to residual disease 1 cm or less. J Clin Oncol. 2007;25(31):4946-51.
10Smith CG, Davenport DL, Gorski J, McDowell A, Burgess BT, Fredericks TI, Baldwin LA, Miller RW, DeSimone CP, Dietrich III CS, Gallion HH. Clinical factors associated with longer hospital stay following ovarian cancer surgery. InHealthcare 2019 Jul 3 (Vol. 7, No. 3, p. 85). MDPI.
11Cancer Research UK. After Having Ovarian Cancer Surgery. Available at: https://www.cancerresearchuk.org/about-cancer/ovarian-cancer/treatment/surgery/after-surgery#:~:text=You%20usually%20go%20home%20about,heavy%20housework%2C%20such%20as%20vacuuming. Accessed November 18, 2023.
12Neurosurgery for brain tumors (adults): information for patients, relatives, and carers. NHS Trust. Imperial College Healthcare. Available at https://www.imperial.nhs.uk/-/media/website/patient-informationleaflets/surgery/neurosurgery/neurosurgery.pdf?rev=8fdb6ef7264942f0bc57f51aaad2056d&sc_lang=en. Accessed 11/10/2023
13Living with a brain tumor: undergoing neurosurgery. NHS Foundation Trust. Cambridge University Hospitals. Available at: https://www.cuh.nhs.uk/patient-information/living-with-a-brain-tumour-undergoing-neurosurgery/. Accessed 11/10/2023.
14Ostrom QT, Gittleman H, Fulop J, Liu M, Blanda R, Kromer C, Wolinsky Y, Kruchko C, Barnholtz-Sloan JS. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008-2012. Neuro-oncology. 2015 Oct 1;17(suppl_4):iv1-62.
15SalcmanM. Survival in glioblastoma: historical perspective. Neurosurgery 1980;7: 435–439.
16Kerth FW, Warnke PC, Scheremet R, Ostertag CB. Surgical resection and radiotherapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme. J Neurosurg. 1983; 78: 762–766
17Vuorinen V, Hinkka S, Färkkilä M, Jääskeläinen J. Debulking or biopsy of malignant glioma in elderly people–a randomised study. Acta neurochirurgica. 2003;145:5-10.
18Dasenbrock HH, Liu KX, Devine CA, Chavakula V, Smith TR, Gormley WB, Dunn IF. Length of hospital stay after craniotomy for tumour: a National Surgical Quality Improvement Program analysis. Neurosurg Focus. 2015; 39(6):E12.
19Surgery. American Brain Tumor Association. Available at https://www.abta.org/wp-content/uploads/2018/03/surgery.pdf. Accessed November 10, 2023.