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Cytoreductive Surgery (CRS)

September 28, 2018

What is Cytoreduction?

Cytoreduction, also known as Cytoreductive Therapy, is a therapy focused on reducing the size of cancerous tumor. Two of the most common cytoreductive treatements are surgery and radiation therapy. These treatments are useful in debulking tumors.

What is Debulking?

As the name suggests, debulking refers to reducing the bulk. In this case, reducing the bulk of cancerous tumor. Since chemotherapy isn’t able to go past large and bulky tumors, debulking cytoreductive surgery may be suggested to the patients in order to increase the efficiency of chemotherapy.

The goal of this surgery is to remove as much visible cancer as possible – the bulk of the cancerous tumor – and to ensure that there aren’t any remaining nodules that measure more than 2 centimeters in diameter.

This surgery is especially recommended and may prove effective for patients who are in the advanced stage of cancer.

Cytoreduction with HIPEC

Cytoreduction therapy, when used with hyperthermic intraperitoneal chemotherapy (HIPEC), is advantageous in cases where cancer that have developed or spread to the abdominal cavity, such as appendiceal cancer, pseudomyxoma peritonei, colon cancer, gastric cancer, ovarian cancer, and peritoneal mesothelioma.

These treatments are given in succession – Cytoreductive surgery, followed by HIPEC.

Cytoreductive surgery focuses on removing the visible parts of tumor, leaving behind only the microscopic cells. If the tumor has spread into other organs, it may be necessary to surgically remove those organs in order to free the affected area of the tumor. Gallbladder, spleen, part of the small or large intestine, and the lining of the abdominal wall (peritoneum) are some of the organs that may be removed.

This surgery is then followed by HIPEC – Hyperthermic Intra PEritoneal Chemotherapy – to destroy any remaining microscopic cancer cells.

During HIPEC, heated chemotherapy solution is administered to abdomen to destroy any remaining cancerous cells. Once the treatment is over, chemotherapy solution is drained from the abdomen and the slit is closed using sterilized equipments.

The temperature of the heated solution is maintained at 42-43°C because cancer cells die at approximately 40°C while a temperature of 44°C is required to destroy normal and healthy cells.

 

[Source:https://www.tuftsmedicalcenter.org/-/media/Brochures/TuftsMC/Patient-Care-Services/Departments-and-Services/Cancer-Center/HIPEC_Final.ashx?la=en&hash=49ECD33312242DC03D3DA5722A6C25C80E5B46A6]

Advantages of Cytoreductive Surgery

Although, there have been many recent developments, the challenge to treat a tumor on the surface of abdominal wall & organs still prevail. When the cancer hasn’t yet spread into the blood stream, HIPEC in combination with cytoreductive surgery proves to be an effective treatment.

Risks of Cytoreductive Surgery

Bleeding and infection are the most common complications post cytoreductive surgery. Other risks associated with the surgery are-

  • Formation of blood cots that may travel to other body parts
  • Enterocutaneous fistula – an opening between the intestines and the abdominal skin
  • Anastomotic leak – a leak that may occur when sections of the intestines are surgically reconnected
  • Reduced calorie intake

Post Cytoreductive Surgery

One of the most common symptoms following cytoreductive surgery is to feel fatigue. While it is important to rest post such an intensive surgery, it is important to move around as much and whenever you can.

Frequent movement will help in preventing possible complications post the surgery, such as, blood cots and pneumonia, and also address fatigue. It is even more important for the patients to try and take up activities of their choice and set health goals throughout the recovery period. This will help patients get back to their normal routine, slowly and steadily, and help them to see their progress throughout the recovery period.

Patients will also have the support of the hospital and the oncology team, post the surgery. Be in touch with your doctor and keep them informed of any changes in your health and appetite. They will be able to guide you to best possible course of action, should you face any trouble.

On the way to recovery

Cytoreductive therapy with HIPEC is a boon and is capable of giving the patients a quality life post the treatment.

Being in touch with your doctor, following the guidelines and the diet suggested by your dietician, doing some moderate physical activity and taking up activities of interest will fortify the efficacy of the treatment.

Cytoreductive therapy with HIPEC is a boon and is capable of giving the patients a quality life post the treatment.

Being in touch with your doctor, following the guidelines and the diet suggested by your dietician, doing some moderate physical activity and taking up activities of interest will fortify the efficacy of the treatment.

Sources:

https://moffitt.org/cancers/ovarian-cancer/debulking-cytoreductive-surgery/

https://www.cancercenter.com/terms/cytoreductive-therapy/

https://www.tuftsmedicalcenter.org/-/media/Brochures/TuftsMC/Patient-Care-Services/Departments-and-Services/Cancer-Center/HIPEC_Final.ashx?la=en&hash=49ECD33312242DC03D3DA5722A6C25C80E5B46A6

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