Debulking is the reduction of as much of the bulk (volume) of a tumour as possible. It is usually achieved by surgical removal.[1][2] When performed for curative intent, surgical debulking of tumors is known as cytoreduction or cytoreductive surgery[3] (CRS); "cytoreduction" refers to reducing the number of tumor cells. Debulking is used with curative intent in only some types of cancer, as generally partial removal of a malignant tumor is not a worthwhile intervention for curative purposes (because malignant cells left behind soon multiply and renew the threat). Ovarian cancer[4] and some types of brain tumor[5] are debulked before radiotherapy or chemotherapy begin, making those therapies more effective. It may also be used in the case of slow-growing tumors to shift tumor cells from phase of cell cycle to replicative pool.
In other types of cancer where debulking is not curative, it is sometimes done with palliative intent to relieve mass effect. For example, tumors whose bulk presses on the lungs or esophagus can impair breathing or swallowing, in which case debulking can improve quality of life[1] and extend survival[1] regardless of not curing the cancer.
Debulking procedures are usually long and often complicated, taking several hours or more to perform, depending on internal involvement and location.
References
^ abcNational Cancer Institute, NCI Dictionary of Cancer Terms: debulking, retrieved 2016-12-01.
^Silberman, AW (1982), "Surgical debulking of tumors.", Surg Gynecol Obstet, 155 (4): 577–585, PMID 6750827.
^Johns Hopkins Medicine Department of Surgery, Cytoreductive Surgery and Heated Chemotherapy, retrieved 2016-12-01.
^American Cancer Society, Surgery for ovarian cancer, retrieved 2016-12-01.
…or restore host immune competence. Surgical cytoreduction is associated with increased survival. The volume of residual disease remaining after cytoreductive surgery correlates inversely with survival …
…biologic features that allow these patients to undergo complete cytoreductive surgery. Furthermore, the quality of the cytoreductive surgery is dependent upon the skills and level of experience of the surgeon …
…Performance status at diagnosis was the strongest predictor of poor outcome. As experience with cytoreductive surgery and intraperitoneal chemotherapy has accumulated, particularly over the last 10 years, marked …
…their initial presentation to determine whether or not they are appropriate candidates for cytoreductive surgery (CRS). The results of the assessment can be used to determine the most appropriate treatment …
…neoadjuvant therapy are ideal candidates for cytoreductive surgery, while patients who respond poorly or progress on NACT are not likely to benefit from surgical cytoreduction because their disease has proven to …
English Journal
The impact of improved treatment strategies on overall survival in glioblastoma patients.
BACKGROUND: The introduction of ALA-Fluorescence-guided surgery (FGS) followed by concomitant radiochemotherapy according to the Stupp-protocol is representative of the major changes in glioblastoma therapy in the past years. We were interested in the impact of this new first-line treatment on the o
Ascites and malnutrition are predictive factors for incomplete cytoreductive surgery for peritoneal carcinomatosis from gastric cancer.
Benizri EI, Bereder JM, Rahili A, Bernard JL, Benchimol D.SourceDepartment of General Surgery and Digestive Cancerology, Centre Hospitalier Universitaire de Nice, Hôpital de l'Archet 2, 151 Route de Saint Antoine de Ginestière, BP 3079, Nice cedex 3, France. Electronic address: benizri.e@chu-nice.fr.
American journal of surgery.Am J Surg.2013 Jun;205(6):668-73. doi: 10.1016/j.amjsurg.2012.06.009. Epub 2013 Jan 28.
BACKGROUND: Prognosis in peritoneal carcinomatosis from gastric cancer has improved with cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy. The aim of this study was to identify predictive factors for incomplete CS.METHODS: Forty-five patients undergoing laparotomy for gastric
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from small bowel adenocarcinoma.
Sun Y, Shen P, Stewart JH, Russell GB, Levine EA.SourceSurgical Oncology Service, Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
The American surgeon.Am Surg.2013 Jun;79(6):644-8.
Peritoneal carcinomatosis arising from small bowel adenocarcinoma (PCSBA) carries a dismal prognosis. Presently, limited data have been published on the outcome of PCSBA treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). This series represents the largest serie
IS-5-3 Survival analysis of patients with pseudomyxoma peritonei of appendiceal origin treated by incomplete cytoreductivesurgery and perioperative intraperitoneal chemotherapy(IS-5 International Session (5) Colorectal surgery)
Yang Liu,Yonemura Yutaka,Ishibashi Haruaki,Mizumoto Akiyoshi,Li Yan
European journal of nuclear medicine and molecular imaging 41(3), 446-451, 2014-03
… Purpose To investigate the impact of PET and PET/CT scanning on decision-making in management planning and to identify the optimal setting for selecting candidates for surgery in suspicious recurrent ovarian cancer. … The total number of patients in whom cytoreductivesurgery was selected as the treatment of choice increased from 12 to 35. … Miliary disseminated disease, which was not detected by PET scan, was found in 22.2 % of those receiving surgery. …