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Debulking is the reduction of as much of the bulk of a tumour without the intention of a complete eradication. It is usually achieved by surgical removal. [1] [2] When performed for curative intent, it is a different procedure, which is called surgical debulking of tumors is known as cytoreduction or cytoreductive surgery [3] (CRS); "cytoreduction" refers to reducing the number of tumor cells.
In 1934, Joe Vincent Meigs in New York originally described tumor debulking surgery (cytoreductive surgery) for ovarian cancer under the premise of reducing macroscopic disease. [7] In the 60s and 70s this aggressive cytoreductive approach began to be accepted.
Ovarian cancer is highly treatable with surgery for almost all cases with well-differentiated stage-1 tumour. [4] [33] Higher tumour grades may benefit from adjuvant treatment such as platinum-based chemotherapy. [4] [33] Optimal debulking is used to treat cases where cancer has spread to become macroscopically advanced.
Debulking surgery has usually only been done once [28] but a recent study has shown a longer overall survival in recurrent ovarian cancer when surgery combined with chemotherapy was performed compared to treatment with chemotherapy alone. [100]
Unilateral surgery is typically employed for germ cell tumors. Achieving complete cytoreduction is essential for managing advanced epithelial ovarian cancer, while debulking surgery aims to remove as much tumor as possible, enhancing the effectiveness of chemotherapy.
As ovarian cancer is rarely symptomatic until an advanced stage, [42] regular pre-emptive screening is a particularly important tool for avoiding the late stage at which most patients present. However, A 2011 US study found that transvaginal ultrasound and cancer marker CA125 screening did not reduce ovarian cancer mortality. [43]
Ovarian cancer is highly treatable with surgery for almost all cases with well-differentiated stage-1 tumour. [31] [33] Higher tumour grades may benefit from adjuvant treatment such as platinum-based chemotherapy. [31] [33] Optimal debulking is used to treat cases where cancer has spread to become macroscopically advanced.
Cytoreductive surgery (CRS) is a surgical procedure that aims to reduce the amount of cancer cells in the abdominal cavity for patients with tumors that have spread intraabdominally (peritoneal carcinomatosis). It is often used to treat ovarian cancer but can also be used for other abdominal malignancies.