TeamCirisano Teaching Series: Debulking Surgery for Gynecologic Cancers

Debulking Surgery for Gynecologic Cancers Gynecologic cancers are often diagnosed at a very advanced stage, once they have already invaded surrounding organs and tissue. In cases such as this, a “debulking surgery” may be the best treatment option. Debulking surgeries are performed in an effort to remove as much of the tumor as possible, with the hope of improving patient prognosis and making them better candidates for chemotherapy. Many patients with advanced ovarian cancer often have severe ascites, as seen here. In this case, a large malignant tumor was noted to have invaded the omentum. After blunt dissection, a vessel sealer was used to cauterize the blood supply and then the tumor and part of the omentum were removed and sent for pathologic evaluation. A Bookwalter retractor was then set up to hold the abdominal walls apart. The uterus, ovaries and any overlying tumors were then isolated with clamps. Sharp and blunt dissection was used to separate the entire specimen from the surrounding tissue and then the entire specimen was carefully removed from the abdominopelvic cavity. A large tumor is seen on the right ovary, and the body of the uterus is noted to be extremely firm to palpation. Upon initial evaluation of the uterus, the body has a fleshy consistency, suggestive of a fibroid. However, the tumor on the right ovary is highly suspicious for malignancy. Another tumor is visualized on the small intestine. After attempting to manually dissect it, it was determined that a small bowel resection would be necessary in order to optimally debulk the tumor. A GIA stapler was first used to divide the affected portions of the small intestine. Once the tumor was isolated from the small intestine, hemostasis was achieved using a large vessel cautery device. The tumor was then removed and sent to pathology. The remaining ends of the small intestine are then carefully aligned and approximated using multiple Allis clamps. A GIA stapler was then used to create a side to side anastamosis. Prior to closing, the anastamosis is thoroughly inspected to ensure proper alignment.