Gynaecological cancer surgery
Debulking Surgery for Advanced Ovarian Cancer
Expert surgical treatment when ovarian cancer has spread.
Being told that ovarian cancer has spread beyond the ovary can be overwhelming. You may have questions about what surgery involves, whether all of the cancer can be removed, what other organs might be affected and what recovery will look like.
At Gynae Solution, we believe you should have a clear understanding of your diagnosis and treatment options. Mr Jafaru Abu, Consultant Gynaecologist and Gynaecological Oncology Surgeon, provides specialist surgical care for women with complex and advanced gynaecological cancers.
For advanced ovarian cancer, treatment commonly involves a combination of surgery and chemotherapy. The precise treatment plan depends on the type and extent of the cancer, your general health and how likely it is that surgery can safely remove all visible disease.
What is debulking surgery?
Debulking surgery, also called cytoreductive surgery, is an operation to remove as much visible ovarian cancer as possible.
When ovarian cancer has spread throughout the abdomen, it may not be possible or safe to remove every area of disease. The aim of maximal cytoreductive surgery is therefore to remove all visible cancer wherever this can be achieved safely.
The amount of cancer remaining after surgery is important when considering the overall treatment plan. Complete cytoreduction, where no visible disease remains, is an important goal of surgery when it can be achieved safely.
Debulking is usually performed as part of a wider treatment programme that also includes chemotherapy. Surgery and chemotherapy work together as part of the treatment of advanced ovarian cancer rather than being considered in isolation.
When might debulking surgery be recommended?
Ovarian cancer is often diagnosed after it has already spread within the abdomen or pelvis. Your specialist team will assess the extent of the disease before deciding whether surgery is appropriate and when it should take place.
There are two main approaches:
Primary debulking surgery
Primary debulking surgery means surgery is performed before chemotherapy.
If investigations suggest that the cancer can be removed successfully and you are well enough to undergo major surgery, your multidisciplinary team may recommend surgery as the first part of treatment.
Interval debulking surgery
For some women with more extensive disease, chemotherapy may be given first. This is known as neoadjuvant chemotherapy.
The chemotherapy can reduce the amount of cancer before surgery, potentially making an extensive operation safer or more effective. Surgery performed after initial chemotherapy is known as interval debulking surgery.
The decision about whether to have surgery before or after chemotherapy is individual and will depend on your scans, the distribution of the cancer, your general health and the likelihood of achieving a successful cytoreduction.
What happens during debulking surgery?
Debulking for advanced ovarian cancer is major abdominal surgery. The precise operation varies considerably from one patient to another because ovarian cancer can spread to different areas of the abdomen.
Standard ovarian cancer surgery commonly involves removal of:
- Both ovaries and fallopian tubes
- The womb and cervix (total hysterectomy)
- The omentum, a fatty layer within the abdomen
- Any visible areas of cancer that can be safely removed
Depending on where the cancer has spread, additional procedures may be necessary. These can include surgery involving the:
- Peritoneum, the lining of the abdomen
- Bowel
- Bladder
- Diaphragm
- Spleen
- Liver
- Stomach
- Pancreas
- Gallbladder
- Lymph nodes
This is why advanced ovarian cancer surgery is highly specialised and requires careful planning and an experienced multidisciplinary team.
Could I need bowel surgery?
Ovarian cancer can involve the bowel, particularly when it has spread extensively throughout the abdomen.
If cancer has affected part of the bowel, your surgeon may need to remove the involved section. In many cases, the remaining ends of the bowel can be joined together.
Sometimes it may not be safe to reconnect the bowel immediately. In this situation, a stoma may be required.
A colostomy or ileostomy creates an opening on the abdomen through which bowel contents leave the body into a specially designed bag. A stoma may be temporary or, depending on the circumstances, permanent.
If there is a possibility that bowel surgery or a stoma may be required, this will be discussed with you carefully before your operation.
Why is removing as much cancer as possible important?
The aim of cytoreductive surgery is to reduce the amount of cancer remaining in the abdomen as much as possible.
Where it can be achieved safely, the preferred surgical outcome is complete cytoreduction, meaning there is no visible cancer remaining at the end of the operation.
The relationship between the amount of disease remaining after surgery and outcomes is an important consideration in the management of advanced ovarian cancer. However, the operation must always balance the potential benefits of removing additional disease against the risks of more extensive surgery.
Importantly, the goal is not simply to perform the biggest possible operation. The aim is to achieve the best possible cancer treatment safely and appropriately for you.
How is it decided whether surgery is suitable?
Before recommending debulking surgery, your specialist team will consider several factors, including:
- The type of ovarian cancer
- The stage and distribution of the disease
- Where the cancer has spread within the abdomen
- Whether the disease appears removable
- Your general health and fitness for major surgery
- Your nutritional status
- Previous treatments
- How you are likely to respond to chemotherapy
- The potential risks and benefits of an extensive operation
You may have CT scans and other investigations to help determine the extent of the cancer and plan your treatment. Your case will usually be discussed by a multidisciplinary team (MDT) of specialists before a treatment recommendation is made.
What are the risks of debulking surgery?
Debulking surgery for advanced ovarian cancer is a major operation and, because it can involve several organs, the risks are greater than those associated with less extensive gynaecological surgery.
Your individual risks will depend on the procedures required and your general health.
Possible complications can include:
- Bleeding and the need for a blood transfusion
- Infection
- Blood clots
- Chest complications
- Injury to surrounding organs
- Bowel complications
- Leakage from a bowel join
- The need for a temporary or permanent stoma
- Bladder or urinary complications
- Delayed return of bowel function
- Wound problems
- The need for further surgery
- A longer hospital stay
There are also risks associated with anaesthesia and with major abdominal surgery generally.
Your surgeon will discuss the potential benefits and risks with you in detail before you decide whether to proceed.
Will I need to have my ovaries and womb removed?
For many women undergoing surgery for advanced ovarian cancer, both ovaries and fallopian tubes, the womb and cervix will need to be removed as part of the operation.
This means that you will no longer be able to become pregnant following surgery. If you have not already gone through the menopause, removal of both ovaries will also result in surgical menopause.
Your fertility, hormonal health and any concerns about menopause should be discussed before treatment wherever possible.
In certain very early ovarian cancers, fertility-sparing surgery may sometimes be appropriate. However, this is generally not possible when extensive surgery is required for advanced disease.
What is recovery like?
Recovery following debulking surgery varies depending on the extent of the operation and whether additional procedures, such as bowel surgery, were required.
You will normally remain in hospital for several days following surgery while your medical team monitors your recovery, pain control, bowel and bladder function, mobility and nutrition.
Your recovery may include:
- Pain relief and careful monitoring
- Gradually increasing your mobility
- Support with eating and drinking
- Monitoring your bowel and bladder function
- Blood tests and other investigations
- Support from specialist nurses and other members of your healthcare team
- Advice about wound care and returning to normal activities
Recovery can take several weeks, particularly after extensive surgery. Your surgeon will give you individual advice about driving, exercise, work, lifting and sexual activity.
If you have undergone bowel surgery or have a stoma, you may need additional support during your recovery.
What happens after surgery?
Surgery is usually only one part of treatment for advanced ovarian cancer.
Depending on your individual circumstances, chemotherapy may have been given before surgery, after surgery, or both. Further treatment will be discussed with you by your oncology team.
Your surgical specimen will also be examined by specialist pathologists. The results provide important information about the type and characteristics of your cancer and help your team plan any further treatment.
You will continue to have follow-up appointments and monitoring after your treatment.
What does debulking surgery mean for my prognosis?
It is completely understandable to want to know what surgery means for your future.
However, there is no single answer that applies to every woman with advanced ovarian cancer. Prognosis depends on several factors, including the type and stage of the cancer, how extensively it has spread, how well it responds to chemotherapy, your general health and the amount of cancer that can be removed safely.
Your consultant will explain your individual circumstances and help you understand what the treatment is intended to achieve.
At Gynae Solution, we believe that honest conversations are an important part of good cancer care. You should have the opportunity to ask questions, understand your options and make decisions with a clear understanding of the potential benefits and risks.
Specialist debulking surgery at Gynae Solution
Advanced ovarian cancer surgery can be complex. It requires careful assessment, detailed planning and an experienced multidisciplinary team.
Mr Jafaru Abu has a specialist interest in gynaecological oncology and complex cancer surgery. His approach is centred around providing patients with clear information, personalised treatment planning and compassionate care throughout their surgical journey.
If you have been diagnosed with advanced ovarian cancer and would like to discuss your surgical options, a specialist consultation can provide an opportunity to review your diagnosis, scans and treatment plan and answer your questions.
We are here to help
If you have been told that you may need debulking surgery for advanced ovarian cancer, you do not have to navigate the decision-making process without support.
Book a consultation with Mr Abu to discuss your diagnosis, treatment options and whether specialist debulking surgery may be appropriate for you.
Patient leaflets
Written for patients, relatives and hospital personnel, to read before your operation and to keep afterwards.
De-bulking Surgery
Why surgeons aim to remove all visible disease, and how the extent of surgery affects survival.
Extensive Ovarian Cancer Surgery
For patients advised to have ultra-radical surgery for advanced ovarian cancer.
iCRS and HIPEC
Surgery after chemotherapy, sometimes combined with heated chemotherapy inside the abdomen.
Common questions
How soon can I be seen?
Daily appointments are available at The Park Hospital. Call the secretary on 0115 966 2049, or send an enquiry below and we will reply within 24 hours on business days.
Do I need a GP referral?
Referrals from GPs are welcome, and you can also enquire directly. If you are using private medical insurance, check with your insurer whether a referral is required for your policy. See GP referrals and fees and insurance.
What does a consultation cost?
A new consultation is £250 and a follow-up consultation is £150. The cost of any tests, procedures or surgery is quoted individually after your consultation. See fees and insurance.
Enquiries
Send us a message
Enquiries from patients and referring clinicians are both welcome. We endeavour to answer all enquiries within 24 hours on business days. If your case is urgent, please say so in your message or call the secretary directly.