Cytoreduction (Debulking) Surgery
Appendix cancer has often spread to the peritoneal surfaces of the abdomen by the time it is discovered. The surgery to remove as much of the cancer in the abdomen as possible, reducing the "bulk" of the cancer is called "debulking" or "cytoreduction" surgery. "Cyto" is a word root meaning cells, so cytoreduction means to surgically "reduce" number of cancer cells. Both terms mean the same thing and are usually used interchangeably.
Cytoreduction (debulking) surgery is often long and complicated and is associated with a high rate of post-operative complications. Parts of the large and small bowel along with organs or parts of organs in the abdomen that are cancerous may need to be removed during this surgery. "Complete cytoreduction" or "complete debulking" means that all of the visible tumors are successfully removed during surgery. "Incomplete cytoreduction" or "incomplete debulking" means that all of the tumors could not be removed during the surgery and that visible tumors were left behind.
The factor most associated with long term survival is completeness of cytoreduction, or the removal of all visible tumors. Cytoreduction (debulking) surgery is best done by a surgical oncologist who specializes in these types of surgeries. A list of some of the specialists can be found on this page: Physicians and Facilities Treating Appendix Cancer.
If all of the tumors cannot be removed, there is less likely hood of survival unless the tumors left behind are very small (less than 2.5mm or about 1/8th of an inch). To destroy very small tumors and cancer cells left behind that are too small to be seen, and to prevent them from later growing into new cancerous tumors in the abdomen, the surgery can be followed by treatment with intraoperative Hyperthermic Intraperitoneal Chemotherapy (HIPEC) or by treatment with early post-operative intraperitoneal chemotherapy (EPIC) at facilities that have the capability to provide these treatments. These chemotherapy treatments may be effective on very tiny tumors that cannot be removed, but are not able to completely destroy larger tumors left behind.
Debulking surgeries can take 12 hours or more and require very large incisions. MOAS is a nickname given to the surgery by a patient who had the procedure done and named it the "Mother Of All Surgeries", and the acronym stuck in some internet circles.
For more information about post-operative complications, see Complications of Cytoreduction Surgery and HIPEC.
Cytoreduction (debulking) surgeries are also done for other cancers that have spread to the peritoneal surfaces of the abdomen such as ovarian, colon, gastric and pancreatic cancers.
A link to a video of cytoreduction surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) performed at Wake Forest University Baptist Medical Center in North Carolina by Drs. Levine, Shen and Stewart:
Intraperitoneal Hyperthermic Peritoneal Chemotherapy for Persistent Cancer in Live Internet Broadcast
If you want to know what questions to ask your surgeon, the US Department of Health and Human Services offers a suggested list of questions in a brochure entitled:
Making Sure Your Surgery is Safe
Hyperthermic Oncology: Cytoreductive Surgery and Intraperitoneal Hyperthermic Perfusion
Current Indications for cytoreductive surgery and intraperitoneal chemotherapy
Appendiceal neoplasms with peritoneal dissemination: outcomes after cytoreductive surgery an intraperitoneal hyperthermic chemotherapy.
Cytoreductive Surgery Combined With Perioperative Intraperitoneal Chemotherapy for the Management of Peritoneal Carcinomatosis From Colorectal Cancer: A Multi-Institutional Study
Long-term survivorship and quality of life after cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis.
Right hemicolectomy does not confer a survival advantage in patients with mucinous carcinoma of the appendix and peritoneal seeding.
Cytoreductive surgery and peri-operative intraperitoneal chemotherapy as a curative approach to pseudomyxoma peritonei syndrome.
Surgical Debulking and Intraperitoneal Chemotherapy for Established Peritoneal Metastases From Colon and Appendix Cancer
Reduced Morbidity Following Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemoperfusion
Heated chemotherapy prolongs survival in abdominal cancer
It's What the Surgeon doesn't See that Kills the Patient
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