2.Primary cytoreductive surgery or debulking:
It is a surgery done to remove the primary tumour as well as associated metastatic disease as much as possible.
Optimal debulking – minimal residual disease = 1-2cm in greatest diameter.
It reduces the volume of ascites.
It is useful in large tumours containing poorly vascularised anoxic areas not accessible to cytotoxic agents and radiation. Removal of omental cake alleviates nausea and early satiety.
Removal of intestinal metastases restores adequate intestinal function.
Improvement of overall nutritional status and ability to tolerate chemotherapy.
Useful in larger tumours have greater proportion of cells in resting phase which are less sensitive to cytotoxic agents.
Useful in phenotypically resistant clones present in large metastatic masses.
Includes pelvic tumour resection, intestinal resection, omentectomy, resection of other metastases.
The performance of debulking operation as early as possible in the course of patient's treatment is considered the standard of care.
Interval cytoreduction:
It is true secondary cytoreduction after suboptimal primary cytoreduction and 3 cycles of chemotherapy.
Primary cytoreductive procedure after a few cycles of chemotherapy. In patients who are poor surgical candidates because of debilitated state related to massive effusion or comorbid conditions.
Referred to oncologist after surgical or nonsurgical biopsy.
With advanced cancer predicted to be suboptimally resected.
Advantages :
To operate on a patient with an improved nutritional status, smaller tumour burden, superior perioperative risk.
Optimal debulking possible. Reduced surgical morbidity.
It is a surgery done to remove the primary tumour as well as associated metastatic disease as much as possible.
Optimal debulking – minimal residual disease = 1-2cm in greatest diameter.
It reduces the volume of ascites.
It is useful in large tumours containing poorly vascularised anoxic areas not accessible to cytotoxic agents and radiation. Removal of omental cake alleviates nausea and early satiety.
Removal of intestinal metastases restores adequate intestinal function.
Improvement of overall nutritional status and ability to tolerate chemotherapy.
Useful in larger tumours have greater proportion of cells in resting phase which are less sensitive to cytotoxic agents.
Useful in phenotypically resistant clones present in large metastatic masses.
Includes pelvic tumour resection, intestinal resection, omentectomy, resection of other metastases.
The performance of debulking operation as early as possible in the course of patient's treatment is considered the standard of care.
Interval cytoreduction:
It is true secondary cytoreduction after suboptimal primary cytoreduction and 3 cycles of chemotherapy.
Primary cytoreductive procedure after a few cycles of chemotherapy. In patients who are poor surgical candidates because of debilitated state related to massive effusion or comorbid conditions.
Referred to oncologist after surgical or nonsurgical biopsy.
With advanced cancer predicted to be suboptimally resected.
Advantages :
To operate on a patient with an improved nutritional status, smaller tumour burden, superior perioperative risk.
Optimal debulking possible. Reduced surgical morbidity.
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