debulking

Debulking, in oncology, refers to procedures aimed at reducing the volume of tumor burden when complete removal is not feasible. The goal is to remove as much visible disease as possible to alleviate symptoms and improve the effectiveness of subsequent treatments such as chemotherapy or radiotherapy. Debulking is distinct from curative resection, which attempts to remove all cancerous tissue.

The most common setting is ovarian cancer, where cytoreductive surgery aims to leave no gross residual disease or, at least, the smallest possible residual tumor. Debulking is also used in brain tumors to reduce mass effect and in other cancers with extensive disease that limits the feasibility of complete resection. The remaining tumor is described as none, minimal, or gross residual, with terminology evolving by cancer type and over time. Historically, optimal debulking in ovarian cancer referred to residual disease under 1 cm, but practice increasingly emphasizes no gross residual disease.

Procedures may be combined with intraoperative chemotherapy or followed by systemic therapy. In select peritoneal cancers, hyperthermic intraperitoneal chemotherapy (HIPEC) is performed at the time of debulking to target microscopic disease.

Outcomes: Debulking can improve symptom control, delay progression, and may improve survival in appropriately selected patients, but it is rarely curative on its own. Prognosis depends on tumor biology, cancer stage, performance status, and response to adjuvant therapies.

Risks include typical surgical complications such as bleeding, infection, organ dysfunction, and extended recovery, with greater morbidity associated with more extensive procedures. Patient selection and multidisciplinary planning are essential. Alternative strategies include neoadjuvant chemotherapy to shrink tumors before surgery or non-surgical therapies when debulking is not feasible.