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> Procedures > Therapeutic or Preventive Procedure > Cytoreductive Surgery

Cytoreductive Surgery

Cytoreductive Surgery is a surgical procedure that aims to remove as much of a tumor or cancerous growth as possible.
This approach is often used in the treatment of advanced-stage cancers, such as ovarian, colorectal, and stomach cancers.
The goal of cytoreductive surgery is to reduce the overall tumor burden, which can improve the effectiveness of subsequent therapies like chemotherapy or radiation.
This procedure may involve the removal of the primary tumor as well as any visible metastatic lesions.
By reducing the amount of cancer present, cytoreductive surgery can enhance a patient's chances of responding to additional treatments and improve overall outcomes.
Researchers and clinicians continue to explore the optimal use of this surgical technique to optimize patient care and improve cancer survivorship.

Most cited protocols related to «Cytoreductive Surgery»

1
Spatial Genomics of Renal Cell Carcinoma
Cited 34 times
We evaluated tumor-biopsy samples from four consecutive patients with metastatic renal-cell carcinoma who were enrolled in the Personalized RNA Interference to Enhance the Delivery of Individualized Cytotoxic and Targeted Therapeutics clinical trial of everolimus (E-PREDICT; EudraCT number, 2009-013381-54) before and after cytoreductive nephrectomy. Biopsy samples were obtained before the initiation of 6 weeks of treatment with everolimus. After a 1-week washout period in which patients did not receive everolimus, a nephrectomy was performed. Everolimus treatment was continued after recovery from surgery until tumor progression. Figure 1 shows biopsy and treatment timelines.
We performed whole-exome multiregion spatial sequencing on DNA that was extracted from freshfrozen samples obtained from Patients 1 and 2, as described previously,19 (link) with paired-end reads of 72 bp and 75 bp, respectively, on Illumina Genome Analyzer IIx and HiSeq platforms. We performed single-nucleotide polymorphism (SNP) array analysis on Illumina Omni2.5 and messenger RNA (mRNA) expression profiling on Affymetrix Gene 1.0 arrays.
All four patients provided written informed consent. Details regarding materials and methods are provided in the Supplementary Appendix, available with the full text of this article at NEJM.org. The study protocol is also available at NEJM.org.
Gerlinger M., Rowan A.J., Horswell S., Math M., Larkin J., Endesfelder D., Gronroos E., Martinez P., Matthews N., Stewart A., Tarpey P., Varela I., Phillimore B., Begum S., McDonald N.Q., Butler A., Jones D., Raine K., Latimer C., Santos C.R., Nohadani M., Eklund A.C., Spencer-Dene B., Clark G., Pickering L., Stamp G., Gore M., Szallasi Z., Downward J., Futreal P.A, & Swanton C. (2012). Intratumor Heterogeneity and Branched Evolution Revealed by Multiregion Sequencing. The New England journal of medicine, 366(10), 883-892.
Publication 2012
Biopsy Cytoreductive Surgery Disease Progression Everolimus Genome Neoplasms Nephrectomy Obstetric Delivery Operative Surgical Procedures Patients Renal Cell Carcinoma RNA, Messenger RNA Interference Single Nucleotide Polymorphism TimeLine
2
Curating Clinically Annotated Ovarian Cancer Microarray Data
Cited 30 times
Our search for clinically annotated ovarian cancer microarray studies identified 21 published studies, which provided 23 publicly available data sets from various sources (Table 1). The search not only targeted studies of primary tumours annotated with patient survival but also included studies providing other potentially valuable clinical annotation. Other main factors of interest included drug resistance, outcome of the primary tumour debulking surgery, histology, stage and grade. We excluded studies not measuring gene expression (i.e. studies of genomic copy number), studies of cell lines, animal models, or non-primary tumours, and data sets not providing clinical information. Expression and clinical data were obtained from the two major public repositories GEO (i) and ArrayExpress (ii), otherwise from supplementary data of the original publications. Data from GEO were obtained using the GEOquery package (31 (link)). Clinical annotations were manually curated using one R script per data set, and original uncurated annotations were retained as a single field. Curated annotations were checked by syntax against a template, which standardized all the known clinically relevant indicators and allowable data values. Clinical data were twice independently curated (authors B.G. and T.R.), and all discrepancies were resolved for the final version. The availability of clinical data varied substantially across datasets (Figure 2).

Available clinical annotation. This heatmap visualizes for each curated clinical characteristic (rows) the availability in each data set (columns). Red indicates that the corresponding characteristic is available for at least one sample in the data set. See Table 2 for descriptions of these characteristics.

Ganzfried B.F., Riester M., Haibe-Kains B., Risch T., Tyekucheva S., Jazic I., Wang X.V., Ahmadifar M., Birrer M.J., Parmigiani G., Huttenhower C, & Waldron L. (2013). curatedOvarianData: clinically annotated data for the ovarian cancer transcriptome. Database: The Journal of Biological Databases and Curation, 2013, bat013.
Publication 2013
Animal Model Cell Lines Cytoreductive Surgery Gene Expression Genome Microarray Analysis Neoplasms Ovarian Cancer Patients Pharmaceutical Preparations R Factors
3
Ovarian Cancer Chemotherapy Response Predictors
Cited 20 times
Microarray gene expression data from frozen tissue samples obtained at the time of primary cytoreductive surgery from two previously-published human ovarian cancer cohorts were also used for the development and independent evaluation of our molecular predictors. The first cohort of 185 primary ovarian tumors treated with adjuvant chemotherapy was originally obtained for identifying prognostic molecular signatures of survival [15] (link). We used the subset of 167 patients with platinum-based chemotherapeutic response information for our predictor development. These patients comprised 112 (67%) complete response (CR), 41 (25%) partial response (PR), and 14 (8%) progress of disease (PD). The second set (Dressman-119) of 119 ovarian cancer patients from the Duke University and H. Lee Moffitt Cancer Center also received platinum-based adjuvant chemotherapy [9] (link). Of 119, 85 (71%) patients had a complete response whereas 34 (29%) patients showed an incomplete response (IR) to the chemotherapy. Expression profiling data of the frozen-tissue tumor samples from both sets were available with Affymetrix HG-U133A GeneChip® arrays.
Ferriss J.S., Kim Y., Duska L., Birrer M., Levine D.A., Moskaluk C., Theodorescu D, & Lee J.K. (2012). Multi-Gene Expression Predictors of Single Drug Responses to Adjuvant Chemotherapy in Ovarian Carcinoma: Predicting Platinum Resistance. PLoS ONE, 7(2), e30550.
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Publication 2012
Biological Markers Chemotherapy, Adjuvant Cytoreductive Surgery Freezing Gene Chips Gene Expression Homo sapiens Malignant Neoplasms Microarray Analysis Neoplasms Ovarian Cancer Ovarian Neoplasm Patients Pharmacotherapy Platinum Tissues
4
Molecular Profiling of MDS Patients
Cited 12 times
A total of 944 adult patients with different MDS subtypes were enrolled in this study, whose bone marrow and peripheral blood samples had been sent for diagnosis to the MLL Munich Leukemia Laboratory between August 2005 and August 2011 (Table 1). The training cohort consisted of 730 patients, the validation cohort of 214 patients. In the training cohort (n=730 patients), follow-up data was available in 670 cases, information on treatment in 648 cases (supportive care: n=504/648, 77.8% azacytidine or lenalidomide: n=62/648, 9.6% cytoreductive treatment only: 22/648, 3.4% acute myeloid leukemia-induction therapy: n=60/648, 9.3%). In the independent validation cohort (n=214 patients), data on follow-up was available in 205, on therapy in 192 patients with a similar distribution of therapeutic strategies (supportive care: n=148/192, 77.1% azacytidine or lenalidomide: n=18/192, 9.4% cytoreductive treatment: n=11/192, 5.7% acute myeloid leukemia-induction therapy: n=15/192; 7.8%). Non-amplified genomic DNA from 53 healthy individuals and paired tumor/normal DNA from an additional 16 MDS cases were also analyzed and used for performance of our data analysis pipelines. All samples were investigated by cytomorphology, chromosome banding analysis, and in part, fluorescence in situ hybridization (Supplementary Table S1), and standard molecular analyses. All patients gave their written informed consent with genetic analyses and with research studies. The study was approved by the internal review boards of the MLL and the University of Tokyo and was following the Declaration of Helsinki.
Haferlach T., Nagata Y., Grossmann V., Okuno Y., Bacher U., Nagae G., Schnittger S., Sanada M., Kon A., Alpermann T., Yoshida K., Roller A., Nadarajah N., Shiraishi Y., Shiozawa Y., Chiba K., Tanaka H., Koeffler H.P., Klein H.U., Dugas M., Aburatani H., Kohlmann A., Miyano S., Haferlach C., Kern W, & Ogawa S. (2013). Landscape of genetic lesions in 944 patients with myelodysplastic syndromes. Leukemia, 28(2), 241-247.
Publication 2013
Adult Azacitidine BLOOD Bone Marrow Cytoreductive Surgery Diagnosis DNA, Neoplasm Fluorescent in Situ Hybridization Genome Lenalidomide Leukemia Leukemia, Myelocytic, Acute Neoadjuvant Therapy Patients
5
Standardized CRS-HIPEC Procedure Protocol
Cited 11 times
The institutions performed the CRS–HIPEC procedure under the same standardized protocol. Extensive debulking with peritonectomy and, when needed, multiorgan resections were performed, as described by Sugarbaker et al.10 (link),11 (link) and all the latter recommendations. The purpose of the cytoreduction was to obtain a macroscopically complete CRS (R1) resection, which means that no macroscopically visible residual tumor was left at the end of the surgical resection. After the cytoreduction, the open perfusion protocol of the abdominal cavity with mitomycin C was performed.17 (link) The inflow temperature of the perfusate was 41–42 °C. As soon as this temperature was reached, mitomycin C was added, 35 mg/m2 body surface, in three fractions (one half, one fourth, and one fourth of the total dose) with a 30-min interval. Mitomycin C was used under the same schedule for all first HIPEC procedures. If a patient had undergone a HIPEC before, procedures were done with intraperitoneal oxaliplatin (460 mg/m2), systemic folinic acid (20 mg/m2), and 5-fluorouracil (5-FU; 400 mg/m2). When new institutions started performing CRS–HIPEC, a surgeon of an experienced institute monitored the procedure to ensure that the procedure was performed according to the Dutch HIPEC protocol.
Kuijpers A.M., Mirck B., Aalbers A.G., Nienhuijs S.W., de Hingh I.H., Wiezer M.J., van Ramshorst B., van Ginkel R.J., Havenga K., Bremers A.J., de Wilt J.H., te Velde E.A, & Verwaal V.J. (2013). Cytoreduction and HIPEC in The Netherlands: Nationwide Long-term Outcome Following the Dutch Protocol. Annals of Surgical Oncology, 20(13), 4224-4230.
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Publication 2013
Abdominal Cavity Cytoreductive Surgery Human Body Hyperthermic Intraperitoneal Chemotherapy Leucovorin Mitomycin OPEN protocol Operative Surgical Procedures Oxaliplatin Patients Perfusion Residual Tumor Surgeons

Most recents protocols related to «Cytoreductive Surgery»

1
Profiling Ovarian Cancer Biomarkers from Plasma and Tissue
A total of 40 samples were collected from four groups of females: Ten plasma samples from patients with pathologically confirmed EOC (mean age, 47 (30 (link)–54 (link)) years), ten plasma samples from matched healthy individuals (HIs) (mean age, 40 (26 –65 (link)) years) eight EOC tissue samples (mean age, 47 (30 (link)–54 (link)) years) and eight benign ovarian (mean age, 40 (17 (link)–70 (link)) years) neoplastic tissue samples. No patients had been administered neoadjuvant chemotherapy and all patients had undergone primary cytoreductive surgery. All cases of OC were histologically diagnosed and classified in accordance with the World Health Organization criteria (7 (link)). For microarray analysis, the first eight samples with best qualified were used in each group; RNA samples extracted from tissues with RIN values >5 were chosen for microarray analysis and the total RNAs extracted from all serum samples were used. 10 samples per group were used for the validation step by RT-qPCR (Table I). The sample collection was performed at Istanbul University Medical Faculty Department of Obstetrics and Gynecology (Istanbul, Turkey) between January 1, 2015 and March 31, 2016. Peripheral blood was collected into EDTA tubes (5 ml) and immediately centrifuged at 3,500 × g for 15 min at 4°C. The serum supernatant was transferred to RNase-free tubes. Sample serum fractions were collected and stored at −80°C until needed. For the collection of tissue, after the routine surgical operation, ~500 mg tissue was deposited in a sterile centrifuge tube containing RNAlater™ stabilization and storage solution (Ambion; Thermo Fisher Scientific, Inc.), stored at 4°C overnight and then stored at −80°C until needed.
Gumusoglu-Acar E., Gunel T., Hosseini M.K., Dogan B., Tekarslan E.E., Gurdamar B., Cevik N., Sezerman U., Topuz S, & Aydinli K. (2023). Metabolic pathways of potential miRNA biomarkers derived from liquid biopsy in epithelial ovarian cancer. Oncology Letters, 25(4), 142.
Publication 2023
BLOOD Cytoreductive Surgery Edetic Acid Endoribonucleases Faculty, Medical Females Microarray Analysis Neoadjuvant Chemotherapy Neoplasms Ovary Patients Plasma RNA Serum Specimen Collection Sterility, Reproductive Tissues
2
Blood Sampling for Breast and Ovarian Cancer
Blood samples were obtained from 31 treatment-naive patients; 18 breast cancer patients and 13 ovarian cancer patients (Supplementary Tables 1 and 2) at St. James’s Hospital, Dublin 8, Ireland between 2018 and 2020. Breast cancer patients with a preoperative indication at multidisciplinary team discussion for neoadjuvant chemotherapy followed by surgery were recruited and ovarian cancer patients scheduled for either primary debulking surgery or neoadjuvant chemotherapy followed by surgery were recruited. A 6 mL K2-EDTA blood sample was taken from each patient for ex vivo culture prior to the initiation of treatment.
Mohamed B.M., Ward M.P., Bates M., Spillane C.D., Kelly T., Martin C., Gallagher M., Heffernan S., Norris L., Kennedy J., Saadeh F.A., Gleeson N., Brooks D.A., Brooks R.D., Selemidis S., O’Toole S, & O’Leary J.J. (2023). Ex vivo expansion of circulating tumour cells (CTCs). Scientific Reports, 13, 3704.
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Publication 2023
BLOOD Cytoreductive Surgery Edetic Acid Malignant Neoplasm of Breast Neoadjuvant Chemotherapy Operative Surgical Procedures Ovarian Cancer Patients
3
STOPGAP Trial: Intraperitoneal Chemotherapy for Gastric Cancer
IP regimen consists of IV Paclitaxel, 5- FU and Leucovorin and IP Paclitaxel (Table 2). Although in PHOENIX GC trial the IP dose was 20 mg/m2, given the safety data for higher doses of IP paclitaxel, we chose an IP dose of 40 mg/m2. However, the systemic backbone portion of the regimen used in PHOENIX GC was adopted as such with the substitution of 5-FU and leucovorin instead of S-1 as S-1 is not available in the United States.

STOPGAP intraperitoneal chemotherapy regimen

AgentDoseRouteSchedule
Leucovorin20 mg/m2IVDays 1 and 8
5-FU400 mg/m2IVDays 1 and 8
Paclitaxel50 mg/m2IVDays 1and 8
Paclitaxel40 mg/m2IPDays 1and 8
Paclitaxel 40 mg/m2 in 500 ml of normal saline will be instilled into the peritoneal cavity through the IP port on days 1 and 8, repeated every 21 days for 4 cycles. In patients with moderate ascites, IP port will be used to drain the fluid prior to delivery of IP treatment. Patients with significant worsening of sensory neuropathy from prior systemic treatment may omit IV Paclitaxel in subsequent cycles. Since all enrolled patients have stage IV disease, the addition of nivolumab 360 mg IV on day 1 of each cycle is permitted based on investigator discretion.
Restaging imaging with CT and /or diffusion weighted MRI with contrast is obtained 4–6 weeks after completion of IP chemotherapy. In the absence of progression, patients may undergo diagnostic laparoscopy with biopsies to assess the extent of PCI and treatment response. At this point, based on response, patients will be triaged to one of the following treatment plans: stable disease or response and PCI > 10—continue IP chemotherapy regimen, progression—switch to second line regimen, response with PCI ≤ 10 and complete cytoreduction is feasible—recommend cytoreduction surgery with HIPEC. Although the CYTOCHIP study showed long term survival benefit was achieved with CRS/HIPEC in patients with PCI ≤ 7, we chose a cutoff of PCI ≤ 10, as the objective of the STOPGAP study is to offer cytoreduction to all eligible patients who have low volume disease in whom a complete cytoreduction is feasible. This is particularly important as the likelihood of prolonged progression free survival without CRS in gastric PC is unlikely. HIPEC is performed using Cisplatin 75 mg/m2 and Mitomycin15 mg/m2 for 90 min at temperature between 41–42 °C. Adjuvant therapy is given based on the discretion of the treating investigator. Routine surveillance with CT scan of the chest, abdomen, and pelvis and/or MRI will be performed every 8–12 weeks. Radiological assessment of disease recurrence will be monitored. Quality of life questionnaire, EQ-5D-5L will be completed by patient every 8 weeks.
Senthil M, & Dayyani F. (2023). Phase II clinical trial of sequential treatment with systemic chemotherapy and intraperitoneal paclitaxel for gastric and gastroesophageal junction peritoneal carcinomatosis - STOPGAP trial. BMC Cancer, 23, 209.
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Publication 2023
Abdomen Ascites Biopsy Chest Cisplatin Cytoreductive Surgery Diffusion Magnetic Resonance Imaging Disease Progression Hyperthermic Intraperitoneal Chemotherapy Infantile Neuroaxonal Dystrophy Laparoscopy Leucovorin Nivolumab Normal Saline Obstetric Delivery Paclitaxel Patients Pelvis Peritoneal Cavity Pharmaceutical Adjuvants Pharmacotherapy Recurrence Safety Stomach Therapeutics Treatment Protocols Vertebral Column X-Ray Computed Tomography X-Rays, Diagnostic
4
Prognostic Value of Perioperative CRP in EOC
We retrospectively reviewed the records of ovarian cancer at Women’s hospital, Zhejiang University School of Medicine between 2002.01.01 and 2016.12.31. The study was approved by the Ethical Committee of women’s hospital, Zhejiang University School of Medicine (IRB-20200230-R). Owing to the retrospective character and the difficulty of recalling all enrolled patients, informed consent was specifically waived by the ethics committee. All the researcher declared to protect patient data confidentiality and compliance with the Declaration of Helsinki. The enrolled patient should meet all the following inclusion criteria: (1) initial treatment was surgery including comprehensive surgical staging or cytoreductive surgery, followed by platinum-based chemotherapy in patients with stage Ic-IV, (2) histological diagnosis of EOC confirmed by Paraffin Section, (3) preoperative blood routine showed normal white blood cell and neutrophil count, (4) available serum CRP within 3 days before operation (preoperative) or within 7 days after operation (postoperative), and (5) available follow-up data of recurrence and death. Exclusion criteria included (1) primary other cancer; (2) the increase of CRP was caused by infection, connective tissue diseases or other inflammatory conditions, judged body temperature, clinical manifestation and auxiliary examination; (3) postoperative complications developed (including postoperative infection and massive bleeding); (4) the first dose of chemotherapy was delayed more than weeks after surgery; (5) only postoperative CRP results were available. Due to the retrospective character of the present study, patients with preoperative CRP results were included for evaluating the prognostic value of preoperative CRP, while patients with both preoperative and postoperative CRP results were included for perioperative CRP.
The clinical information of each selected patient was collected from the hospital database, and survival status was followed up by phone. The variables included age at diagnosis, histological type, FIGO stage, tumor grade, preoperative and postoperative serum CRP, preoperative serum CA125, postoperative residual tumor after primary surgery, chemotherapy sensitivity and the time of recurrence, death or last follow-up. Serum CRP was detected by immunoturbidimetry as part of the clinical routine management. Chemotherapy resistance was defined as having a time with recurrence of disease ≤6 months after completion of primary chemotherapy. Overall survival (OS) time was calculated as the interval between the date of primary surgery and the date of last follow-up or death. PFS was calculated as the interval from the date of primary surgery to the time of detected recurrence or progression.
Pan Q., Wei M., Lu M., Xu Y., Xie X, & Li X. (2023). The Role of Perioperative C-Reactive Protein in Predicting the Prognosis of Epithelial Ovarian Carcinoma. Cancer Management and Research, 15, 233-243.
Publication 2023
4-maleimido-2,2,6,6-tetramethylpiperidinooxyl BLOOD Body Temperature CA-125 Antigen Character Connective Tissue Diseases Cytoreductive Surgery Diagnosis Disease Progression Ethics Committees Hypersensitivity Immunoturbidimetry Infection Inflammation Leukocytes Malignant Neoplasms Neoplasms Neutrophil Operative Surgical Procedures Ovarian Cancer Paraffin Patients Pharmacotherapy Platinum Postoperative Complications Recurrence Residual Tumor Serum Woman
5
Bevacizumab for Recurrent Ovarian Cancer
We performed a multi-institution retrospective analysis of patients who received bevacizumab for recurrent ovarian, fallopian tube, and peritoneal cancer from 2004 to 2014 at the following institutions: Northwestern University, Swedish Cancer Institute (Seattle), University of Pennsylvania, and University of Washington. Other criteria included having biopsy-confirmed diagnosis and the use of cytoreductive surgery and cytotoxic chemotherapy as part of their initial treatment. Patients were excluded if their medical records were incomplete regarding primary outcome, if they had a concurrent malignancy, or if they received bevacizumab as part of their initial treatment. The Institutional Review Board at each participating institution approved this study.
Ghezelayagh T.S., Wu E.S., Barber E.L., Dao M.D., Zsiros E., Urban R.R., Gray H.J., Goff B.A., Shah C.A., Neubauer N.L., Dai J.Y., Tanyi J.L, & Liao J.B. (2023). Timing and duration of bevacizumab treatment and survival in patients with recurrent ovarian, fallopian tube, and peritoneal cancer: a multi-institution study. European journal of gynaecological oncology, 44(1), 17-25.
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Publication 2023
Bevacizumab Biopsy Cytoreductive Surgery Diagnosis Ethics Committees, Research Fallopian Tubes Malignant Neoplasms Ovary Patients Peritoneum Pharmacotherapy

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More about "Cytoreductive Surgery"

Cytoreductive surgery, also known as debulking surgery, is a medical procedure in which the majority of a cancerous tumor or tumors are surgically removed.
This approach is commonly used to treat advanced-stage cancers, such as ovarian, colorectal, and gastric (stomach) cancers.
The primary goal of cytoreductive surgery is to reduce the overall tumor burden, which can enhance the effectiveness of subsequent therapies like chemotherapy or radiation.
During this procedure, the surgeon will attempt to remove the primary tumor as well as any visible metastatic lesions (secondary tumors) throughout the body.
By reducing the amount of cancer present, cytoreductive surgery can improve a patient's chances of responding to additional treatments and ultimately enhance their overall outcomes and survivorship.
Researchers and clinicians continue to explore the optimal use of this surgical technique, utilizing tools like SAS 9.4, Collagenase type IV, DMEM/F12, SPSS version 22.0, Ficoll-Paque™ PLUS Media, 70 μm cell strainers, INtuition software, TRIzol, and R software to analyze data and refine protocols.
The aim is to continually improve patient care and maximize the benefits of cytoreductive surgery, also known as debulking surgery, for individuals battling advanced-stage cancers.