Cytoreductive Surgery For Advanced Ovarian Cancer- What Patients And Caregivers Should Know

Ovarian cancer is often diagnosed at an advanced stage, when the disease has spread throughout the abdominal cavity. A key characteristic of this cancer is its tendency to spread to the peritoneum—the inner lining of the abdomen. About 75% or more of patients have widespread peritoneal involvement (classified as Stage 3), while some may also have cancer in the chest cavity (Stage 4). The standard treatment for advanced ovarian cancer includes surgery (to remove as much of the tumor as possible) followed by chemotherapy (typically six cycles for most patients). At Shalby Hospital SG Ahmedabad, we offer a robust combination of cytoreductive surgery and chemotherapy, providing holistic and effective care for advanced ovarian cancer.

What Is Cytoreductive Surgery?

The surgery that is performed to remove the tumor from the abdominal cavity or peritoneum is called “cytoreductive surgery”. Cytoreductive surgery involves removal of the peritoneum bearing the tumor (known as peritonectomy) and resection of any of the organs that are involved by the tumor. The uterus with both ovaries and fallopian tubes are removed for all patients with advanced ovarian cancer. In addition, segments of the large intestine, small intestine, gall bladder, and the spleen may be removed if required.

The main goal of the surgery is to leave behind no visible tumor. At the same time, surgery should have no long-term consequences on the patient’s day-to-day life enabling her to lead a normal life once the recovery period after surgery is over.

Some patients with very extensive disease that cannot be removed completely are given a few courses of chemotherapy first to shrink the tumor and surgery if performed after that.

Why Is Cytoreductive Surgery So Challenging?

This isn’t just another abdominal surgery — it’s one of the most complex. A surgeon performing CRS must be skilled in operating across every part of the abdominal cavity. Tiny tumor nodules might be scattered across areas that aren’t clearly visible on CT scans, PET scans, or MRIs. These “hidden” cancer cells can only be spotted once the abdomen is opened during surgery.

Some particularly challenging areas include:

• Around the liver
• The diaphragm (muscle separating chest and abdomen)
• Near the stomach and intestines
  

This complexity makes experience and surgical precision critical. In fact, studies show that specialized teams can successfully remove all visible tumors in over 90% of patients — which is crucial, because any leftover tumor increases the risk of cancer returning.

Often, a diagnostic laparoscopy is done before CRS to assess whether the tumor can be completely removed and to help plan the procedure accordingly.

 
How Is Cytoreductive Surgery Different from Other Abdominal Surgeries?

Compared to other abdominal cancer surgeries, cytoreductive surgery is much more extensive:

• Duration: The procedure can take anywhere from 4 to 8 hours, depending on the spread of the disease and the complexity of removal.
• Hospital Stay: Patients typically stay in the ICU for 1-2 days post-surgery and remain hospitalized for 8-14 days overall.
• Surgical Method: Unlike many abdominal surgeries that can be performed laparoscopically or robotically, cytoreductive surgery requires an open approach to avoid missing any disease.
• Multiple Organs Involved: Most abdominal surgeries target a single organ or region. In contrast, cytoreductive surgery addresses multiple areas and organs within the abdomen.

Because of its complexity, this surgery demands a high level of surgical expertise, comprehensive preoperative planning, and a longer recovery period.

Peritoneal Cancer Can Involve Any Part Of The Abdominal Cavity

Major abdominal cancer surgeries involve only one region or organ system – for e.g., the liver or the colon or the rectum or the small intestine while multiple regions of the abdominal cavity are addressed during cytoreductive surgery and more than one organ may be removed.

Cytoreductive surgery is always performed by the open route (putting a big cut on the tummy) as there is a high risk of missing disease during laparoscopy and some procedures are not feasible by laparoscopy. Thus, cytoreductive surgery is more complex than the average abdominal cancer surgery, takes longer to perform and requires a longer stay in the intensive care unit and hospital both.

Why Is Cytoreductive Surgery Expensive?
Cytoreductive surgery tends to cost 20–40% more than average cancer surgeries. The reasons include:

• Longer surgery time
• Greater use of resources (equipment, surgical teams, ICU care)
• Longer hospital stays
• Higher risk of complications, requiring intensive monitoring and management

But this investment — in time, resources, and effort — often pays off with better survival outcomes and quality of life when performed successfully by an experienced team.

Questions To Ask Before Cytoreductive Surgery

When you are considering cytoreductive surgery for ovarian cancer, it is helpful to discuss all the following issues with your surgical team-

• How extensive is the disease, and is complete tumor removal possible?
• What are the expected short- and long-term effects of the surgery?
• What is the estimated hospital stay?
• What can be done to reduce the chances of complications and promote faster recovery?

Remember, there is a price to pay for everything-both in terms of the actual cost of surgery and the impact on the patient’s health. Some investments are heavy or tough but also lead to larger gains in terms of survival and preservation of quality of life.

The Multidisciplinary Team For Performing CRS And HIPEC

Cytoreductive surgery and HIPEC is a complex and morbid procedure. Over the years, the morbidity has become similar to other major cancer surgeries due to the efforts not just of surgeons but of the entire team. It has been shown that it takes a surgeon, 120-140 cases to gain expertise and a similar number for the institution.

The multidisciplinary team comprises of

1. Radiologists – To map the exact extent of the disease.
2. Pathologists – To provide accurate tumor diagnosis and grading.
3. Prehabilitation Specialists – Including surgeons, physicians, anesthesiologists, and nutritionists, all preparing the patient weeks before surgery.
4. Experienced Surgeons – Typically needing to perform over 120–150 cases to master the procedure.
5. Anesthesiologists – Responsible for managing fluid balance, pain control, and intraoperative challenges.
6. ICU Team – Expert intensivists who monitor and manage complications 24/7.
7. Rehabilitation Experts – Including physiotherapists and nutritionists who help patients recover strength, mobility, and nutrition post-surgery.
   
   

Even the assistant surgeons play a critical role — since these surgeries are long and require unflinching attention and teamwork throughout.

All departments have to work in sync and co-ordinate with each other at all times. When communicating the risk and prognosis to the patient and their families, all consultants should portray a similar picture. The acceptable mortality rate for this procedure is around 1%.

The other group of very complicated and unusual surgeries happening in the department that will indirectly benefit from putting this system in place is the gastrointestinal, thoracic and hepatobiliary surgeries.

Conclusion
Cytoreductive surgery may sound intimidating, but with the right team, preparation, and post-operative care, it offers many women a fighting chance against a formidable disease. While the journey is tough, it is also one filled with resilience, hope, and the potential for longer survival and better quality of life. It’s not just about removing cancer — it’s about empowering patients to live fully again. At Shalby Hospital SG Ahmedabad, we are with you at every step — from diagnosis to recovery — with compassion, commitment, and world-class expertise. Call us at 7069 001 001 to connect with our experts and understand the best way forward. Book an Appointment Now!