Debulking Surgery for Ovarian Cancer: What It Is and What to Expect

Debulking surgery for ovarian cancer is often a critical first step in treatment. It’s not just about removing what’s visible — it’s about giving your body the best fighting chance against this disease. 

When ovarian cancer spreads, it can affect multiple organs and tissues in your abdomen and pelvis. Debulking surgery aims to remove as much of the cancer as possible, which can improve how well any subsequent treatment plan works afterward.

Let’s be honest: facing debulking surgery can be overwhelming. There’s a lot to understand, from what happens during the procedure to recovery and beyond. We’re here to break it down for you.

What is Debulking Surgery for Ovarian Cancer?

Debulking surgery (also called cytoreduction surgery) is a procedure where surgeons remove as much of the visible cancer as safely possible. The technical term “cytoreduction” simply means reducing the number of cancer cells in the body.

When doctors talk about “optimal debulking,” they’re referring to surgery that leaves behind no visible cancer or only tumors smaller than 1 cm (about half an inch). This is the goal: to remove as much cancer as possible, making any remaining cancer cells more vulnerable to chemotherapy.

For most women with advanced ovarian cancer (stages III and IV), debulking surgery is a major operation that might include:

• Removing both ovaries and fallopian tubes (bilateral salpingo-oophorectomy)
• Removing the uterus (hysterectomy)
• Removing the omentum, a fatty tissue that covers your abdominal organs (omentectomy)
• Removing affected lymph nodes
• Taking biopsies from different areas in your abdomen
• Removing portions of other organs if the cancer has spread (such as parts of the bowel, bladder, spleen, liver, diaphragm, appendix, or stomach)

Every case is different. Your surgical plan will depend on how far your cancer has spread, your overall health, and sometimes your future fertility goals if that’s important to you.

Primary vs. Interval Debulking Surgery

There are two main approaches to debulking surgery for ovarian cancer:

Primary debulking surgery happens before any other treatment. Surgeons remove as much cancer as possible, then you’ll typically start chemotherapy for ovarian cancer afterward.

Interval debulking surgery happens after you’ve had a few rounds of chemotherapy. This approach might be recommended if your cancer is very extensive at diagnosis or if you have other health issues that make immediate extensive surgery risky. The chemotherapy helps shrink the tumors first, potentially making the surgery more effective and less complicated.

Recent research found that both approaches have similar effectiveness in terms of survival when used appropriately, but they have different side effect profiles. Primary debulking tends to be more extensive with higher complication rates, while interval debulking after chemotherapy often requires less extensive surgery.

What Happens Before Debulking Surgery?

Preparation is key to successful surgery and recovery. Before your debulking operation for ovarian cancer, you’ll go through several important steps.

Diagnosis and Staging

First, your medical team needs to confirm you have ovarian cancer and determine how far it has spread. This typically involves:

• Blood tests, including CA-125 ovarian cancer screening (CA-125 is a protein that can be elevated with ovarian cancer)
• Imaging studies like CT scans, MRIs, or ultrasounds
• Sometimes, a diagnostic laparoscopy (a surgical procedure where a surgeon uses a thin, lighted tube to look inside your abdomen)

This information helps your doctors determine if debulking surgery is right for you and what approach to take.

Meeting Your Surgical Team

You’ll meet with a gynecologic oncologist, a surgeon specializing in cancers of the female reproductive system. Outcomes are typically better when these surgeries are performed by specialists with extensive experience in ovarian cancer treatment. One study shows that surgeries performed by gynecologic oncologists can result in survival rates as much as 30% greater compared to those performed by less experienced surgeons, including general surgeons, benign gynecologists, or general OB/GYNs.

During this consultation, your surgeon will:

• Explain what will happen during surgery
• Discuss potential risks and benefits
• Answer your questions
• Ask you to sign consent forms

Don’t be afraid to ask questions. Understanding what’s ahead helps reduce anxiety and allows you to prepare properly.

Pre-Surgical Testing

Your medical team will perform several tests to make sure you’re healthy enough for major surgery:

• Comprehensive blood tests
• Additional imaging if needed

It’s important to be honest about your complete medical history, including any medications, supplements, or herbs you take regularly.

Physical Preparation

In the days or weeks before surgery, you may be advised to:

• Stop taking certain medications, especially blood thinners
• Quit smoking (even temporarily) as smoking increases surgical complications
• Follow specific instructions about eating and drinking before surgery
• Prepare your home for recovery (like arranging for help, preparing meals in advance)

Your doctor might recommend a bowel prep the day before surgery, which cleanses your digestive system. This is especially important if there’s a chance that your surgeon might need to remove part of your intestines.

The Debulking Surgery Procedure

On the day of your debulking operation for ovarian cancer, several things will happen:

• Anesthesia: You’ll receive general anesthesia to ensure you’re completely asleep and pain-free during the procedure.
• Incision: Depending on your specific case and surgical approach, your surgeon will either:
  • Make a vertical incision down the center of your abdomen (open surgery), which gives them the best access to examine all areas where ovarian cancer might have spread, or
  • Create several small incisions (laparoscopic surgery) to insert a camera and specialized instruments. This minimally invasive approach may be an option in select cases, though extensive debulking is often performed through an open incision to ensure optimal tumor removal.
• Exploration: The surgeon will carefully examine your entire abdominal cavity to assess the extent of the cancer.
• Removal: They’ll remove as much visible cancer as safely possible, which may include: 
  • Both ovaries and fallopian tubes
  • The uterus
  • The omentum
  • Any visible tumor deposits throughout the abdomen and pelvis
  • Potentially parts of other organs if the cancer has spread there
•  Staging: Biopsies will be taken from various areas to determine if cancer cells have spread beyond what’s visible.
• Reconstruction: If parts of your bowel or other organs were removed, your surgeon will repair or reconnect them.
• Closure: Finally, your incision will be closed with staples or stitches.

The entire procedure typically takes several hours — anywhere from 3 to 8 hours or more, depending on how extensive the cancer is and what needs to be removed.

What Are Debulking Surgery Side Effects?

Like any major surgery, debulking surgery for ovarian cancer comes with potential side effects and complications. Understanding these in advance can help you prepare mentally and physically.

Short-Term Side Effects

Immediately after surgery, you may experience:

• Pain and discomfort: This is normal after any major abdominal surgery. Your medical team will provide pain medication to keep you comfortable.
• Fatigue: Expect to feel extremely tired for several weeks. Your body is using a lot of energy to heal.
• Temporary bowel issues: Constipation, diarrhea, or ileus (temporary slowing of bowel function) can occur after abdominal surgery.
• Nausea: Some people experience nausea from anesthesia, pain medications, or changes to digestive function.
• Urinary catheter: You’ll likely have a catheter for a short time after surgery to drain urine from your bladder.
• IV fluids and drains: These help maintain hydration and remove excess fluid from your surgical area.

Potential Complications

More serious complications can occur, though they’re less common:

• Infection: Surgical site infections, pneumonia, or urinary tract infections may develop.
• Bleeding: Although rare, excessive bleeding may require additional surgery or blood transfusions.
• Blood clots: Surgery increases your risk of developing blood clots in your legs (deep vein thrombosis) that can travel to your lungs (pulmonary embolism).
• Damage to nearby organs: The bladder, ureters, or intestines may be injured during surgery.
• Fistula formation: Abnormal connections between organs or between an organ and your skin can develop.
• Wound complications: Your incision may heal slowly or partially reopen.

According to research, major post-operative complications were more common with primary debulking surgery (25.9%) compared to interval debulking after chemotherapy (7.6%). The most common serious complication was pleural effusion (fluid around the lungs) requiring drainage.

Long-Term Effects

Some effects of debulking surgery are permanent:

• Surgical menopause: If both ovaries are removed, you’ll experience immediate surgery-induced menopause with symptoms like hot flashes, mood changes, and vaginal dryness if you haven’t gone through menopause already.
• Fertility loss: If your uterus and/or both ovaries are removed, you won’t be able to become pregnant naturally. If fertility is important to you, discuss options like egg-freezing with your doctor before surgery.
• Lymphedema: If lymph nodes are removed, you may develop swelling in your legs or lower body.
• Changed bowel habits: If portions of your intestines were removed, you may notice permanent changes in bowel function.
• Ostomy: In some cases, if a portion of the bowel is removed, you might need a temporary or permanent colostomy or ileostomy (openings in the abdomen for waste to exit into a bag).

Recovery from Debulking Surgery

Recovery after debulking surgery for ovarian cancer is a process that takes time. Here’s what to expect:

Hospital Stay

You’ll typically stay in the hospital for about 3 to 7 days after surgery. During this time:

• Your medical team will monitor your vital signs and pain levels
• You’ll gradually progress from liquids to solid foods
• Physical therapists will help you get moving to prevent complications
• You’ll learn how to care for your incision

At Home Recovery

Once home, full recovery may take 6 to 8 weeks or longer. During this time:

• Rest when tired: Listen to your body and take naps when needed.
• Gradually increase activity: Start with short walks and slowly build up your strength and stamina.
• Avoid heavy lifting: Don’t lift anything heavier than 5 pounds (about the weight of a gallon of milk) for at least 6 weeks.
• Eat nutritiously: Focus on protein-rich foods to help healing and prevent muscle loss.
• Stay hydrated: Drink plenty of fluids to help your body recover.
• Care for your incision: Follow instructions for keeping it clean and dry.
• Take medications as prescribed: This might include pain relievers, blood thinners, or antibiotics.

Most women can return to work and normal activities within 6 to 8 weeks, though this varies based on individual circumstances and the extent of your surgery.

What Are the Success Rates for Debulking Surgery?

The success of debulking surgery for ovarian cancer can be measured in different ways.

Surgical Success

Surgical success is often defined by how much cancer remains after surgery:

• Complete debulking (R0): No visible tumor remains
• Optimal debulking: Tumors less than 1 cm remain
• Suboptimal debulking: Tumors larger than 1 cm remain

According to research, the rates of complete resection vary significantly between treatment approaches. One study found complete resection rates of 47.6% with primary debulking surgery versus 77.0% with interval debulking after chemotherapy.

The amount of remaining tumor is one of the strongest predictors of outcomes. Patients with no visible remaining cancer have better survival rates than those with residual disease.

Survival Outcomes

Ultimately, the most important measure of success is how debulking surgery affects survival. According to research:

• Median progression-free survival (time before cancer returns) was about 15 months for primary debulking surgery and 14 months for neoadjuvant chemotherapy followed by interval debulking.
• The median overall survival was 41 months for primary debulking and 43 months for the neoadjuvant approach.

Research shows that patients who undergo surgery performed by gynecologic oncologists at high-volume centers tend to have better outcomes.

Questions to Ask Your Doctor

Before undergoing debulking surgery for ovarian cancer, consider asking your doctor:

• Am I a candidate for primary debulking surgery, or would neoadjuvant chemotherapy followed by interval debulking be better for me?
• What organs or tissues might need to be removed during my surgery?
• What is the likelihood you’ll be able to remove all visible cancer?
• What are the specific risks in my case?
• How many of these procedures have you performed?
• What can I expect during recovery?
• Will I need an ostomy? If so, will it be temporary or permanent?
• When will I start chemotherapy after surgery?
• How will this surgery affect my fertility and hormone levels?
• Are there any clinical trials I should consider?

Finding Hope and Support

Facing ovarian cancer and debulking surgery can be frightening, but you’re not alone. Connect with support groups at your treatment center, organizations like Not These Ovaries, or counselors. You may also simply reach out to friends and family for practical help. 

Remember that while ovarian cancer debulking surgery is challenging, it’s an essential step toward fighting your cancer and giving chemotherapy the best chance to work. With advancements in surgical techniques, outcomes continue to improve. At Not These Ovaries, we’re funding research for better treatments and eventually cures. Together, we can make a difference.