Cytoreductive surgery removes tumors that have spread throughout your abdominal cavity. It’s often combined with another procedure called hyperthermic intraperitoneal chemotherapy.

You may need cytoreductive surgery if you have advanced abdominal cancer that has spread beyond its original location. Some of the types of cancer it’s used to treat include those that originate in your:

  • liver
  • pancreas
  • ovaries

The purpose of cytoreductive surgery is usually to prolong survival and reduce disease symptoms. However, it can potentially be curative for a small number of people.

You may receive hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery. HIPEC involves washing out your abdominal cavity with warmed chemotherapy drugs to remove the remaining cancer missed during surgery.

This article examines cytoreductive surgery in more detail, including the purpose, procedure, and potential risks.

The goal of cytoreductive surgery is usually to improve survival time and quality of life for those with advanced abdominal cancers.

It’s performed in people with advanced cancer that has spread to the peritoneum (a membrane that lines the abdominopelvic cavity) from the:

  • appendix
  • large intestines
  • small intestines
  • rectum
  • ovaries
  • liver
  • pancreas
  • stomach

Cytoreductive surgery offers some benefits, such as potentially:

  • increasing quality of life
  • increasing survival
  • relieving symptoms
  • reducing cancer recurrence
  • improving in daily function

Cytoreductive surgery alongside HIPEC

Hyperthermic intraperitoneal chemotherapy is often combined with HIPEC to kill even more cancer cells.

During cytoreductive surgery, your surgeon removes as many cancer cells as possible, but they may miss clusters of cancer cells too small to be seen.

HIPEC involves warming chemotherapy drugs and using them to flush out your abdominal cavity to destroy remaining cancer cells. Chemotherapy drugs primarily target quickly replicating cells, such as cancer cells.

The addition of HIPEC may improve the survival of some types of cancer. For example, in a 2019 study, researchers examined the survival benefit of adding HIPEC to cytoreductive surgery for people with stomach cancer that spread to the lining of their abdominal cavity.

Half of the people treated with both lived at least 18.8 months. Half of the people given cytoreductive surgery only lived 12.1 months.

Every surgical procedure comes with risk. Cytoreductive surgery is generally considered a high risk procedure, and a mortality rate as high as 8% has been reported.

Some of the risks of cytoreductive surgery include:

Cytoreductive surgery can help prolong survival for many people, but its exact effectiveness depends on factors such as:

  • the extent of your cancer
  • the type of cancer you have
  • your overall health
  • your age

In a 2023 study, researchers examined the survival benefit of cytoreductive surgery and HIPEC for people with colorectal cancer that had spread to distant locations.

Among the 103 people in the study who received these treatments, researchers reported that half lived at least 42.5 months, and the 5-year overall survival was 36%.

Here’s a general idea of what to expect before, during, and after cytoreductive surgery.

Before the procedure

Cytoreductive surgery is performed under general anesthesia, meaning you’ll be asleep during the procedure. Before your surgery, you’ll be given preoperative drinks to take to help clear out your bowels.

You’ll receive imaging tests ahead of your procedure so your surgeon can see the extent and location of your cancer.

During the procedure

Cytoreductive surgery is very intensive and can take 6 to 12 hours.

  1. You’ll receive a general anesthetic through a mask or IV inserted into your wrist or arm.
  2. Once you’re asleep, your surgeon will make a large incision in your abdomen to access your organs.
  3. Your surgeon will remove any cancerous cells that they identify throughout your abdominal cavity.
  4. If you’re also receiving HIPEC, they’ll warm chemotherapy drugs to roughly 42°C (108°F) and use these medications to rinse your abdominal cavity.
  5. Your surgeon will close your wounds with stitches or clips and cover your wounds with bandages.

After the procedure

You’ll wake up in the recovery area after your procedure and will be closely monitored for complications. You’ll likely have abdominal soreness when you wake up and will likely have a catheter inserted into your bladder.

You’ll have a pre-operative assessment before your procedure, where doctors run tests to see the extent of your cancer and measure your overall health.

You’ll need to stop eating and drinking hours in advance of cytoreductive surgery. Your surgical team will tell you how far in advance you need to stop eating, but it’s often recommended to avoid solid food for at least 6 hours and liquids for 2 hours.

You’ll normally be in the hospital for 10 to 14 days following cytoreductive surgery. It can take months to recover to the level of functioning you had before your procedure.

Two-stage cytoreductive surgery has emerged as a potential alternative for some people. Two-stage cytoreductive surgery involves receiving multiple surgeries to remove the cancer instead of one procedure.

The cost of cytoreductive surgery depends on factors like:

  • the experience of your surgeon
  • your geographic location
  • the extent of the procedure

In a 2021 study, researchers reported an average cost of $20,509 among 59 people who received 61 procedures.

What’s the difference between cytoreductive surgery and debulking surgery?

Debulking surgery is another name for cytoreductive surgery.

What is the life expectancy after cytoreductive and HIPEC surgery?

The life expectancy after cytoreductive surgery and HIPEC varies based on factors like your overall health and where your cancer originated.

In a 2024 study, researchers reported half of people who received these treatments for advanced colorectal cancer survived at least 42.5 months.

Cytoreductive surgery is a procedure used to remove cancer that has spread throughout your abdominal cavity from its original location. It’s often combined with another procedure called HIPEC, which involves rinsing out your abdominal cavity with warmed chemotherapy drugs.

Cytoreductive surgery can help prolong the survival of people with advanced abdominal cancer. The goal is generally to prolong survival versus trying to cure the cancer.