Cytoreductive surgery has become a key tool in the treatment of certain advanced cancers, particularly those affecting the abdomen. Its purpose is not simply to remove a single tumour, but to reduce the visible disease burden as much as possible, which provides a significant survival benefit and meaningfully improves the effectiveness of other treatments.
Unlike more localised surgical procedures, this intervention requires complex planning and an individualised assessment of each patient.
What is cytoreduction and what is its purpose?
Complete cytoreductive surgery consists of removing all visible tumour tissue inside the abdominal cavity. It is applied especially in cases of peritoneal carcinomatosis.
The underlying principle is clear: eliminate intra-abdominal disease to the greatest possible extent, since there is a direct relationship between the amount of residual tumour at the end of surgery and subsequent oncological outcomes.
In some patients, this strategy is combined with techniques such as Hyperthermic Intraperitoneal Chemotherapy (HIPEC), which delivers chemotherapy directly into the affected area after the resection — targeting the microscopic disease that surgery cannot see.
When is it indicated?
Not every cancer patient is a candidate for cytoreductive surgery. The indication depends on multiple clinical factors and must be assessed by a team specialised in oncological surgery. Key criteria include:
• Tumour type and histology
• Extent within the abdomen (Peritoneal Cancer Index, PCI)
• Patient's overall condition and functional reserve
• Realistic possibility of removing the majority of the visible disease
This type of surgery is most frequently used in:
• Selected cases of advanced ovarian cancer
• Colorectal tumours with peritoneal spread
• Gastric cancer in selected cases
How is the procedure performed?
Cytoreductive surgery is a complex procedure that can last several hours. During the operation, the surgical team directly assesses the extent of disease and proceeds to remove all visible tumour deposits.
Depending on each case, it may be necessary to partially resect affected organs: selective peritonectomies, omentectomy, bowel resections, splenectomy, cholecystectomy or more extensive oncological resections according to disease spread. When liver involvement is present, a liver resection can be combined in the same surgical act.
The aim is always to achieve the highest grade of cytoreduction possible (CC-0 or CC-1), since this factor is directly linked to subsequent outcomes in terms of survival and disease control.
When combined with HIPEC, heated chemotherapy (41–43°C) is delivered into the abdominal cavity for 60–90 minutes after completing the resection, in order to act on possible microscopic residual disease. In cases where complete cytoreduction is not feasible, alternatives such as PIPAC (Pressurised Intraperitoneal Aerosol Chemotherapy) are evaluated. You can read more about cytoreductive surgery applied to peritoneal carcinomatosis.
Results and expectations
Outcomes of cytoreductive surgery vary according to tumour type and the patient's clinical situation. Clinical trials show that it is one of the most relevant treatments in cases of peritoneal carcinomatosis, contributing to longer survival and better disease control.
It is important to understand that this is not always curative surgery. In many cases it forms part of a broader therapeutic strategy aimed at controlling the disease and improving the patient's quality of life.
The experience of the surgical team and appropriate patient selection are decisive factors in the final results — both for survival and for postoperative complications.
Risks and recovery
As with any major surgery, cytoreduction involves risks that must be assessed individually. These include:
• General postoperative complications (bleeding, anastomotic leaks, dehiscence)
• Intra-abdominal or wound infections
• Prolonged recovery with a significant period of hospitalisation
• Chemotherapy-related toxicity when combined with HIPEC (see side effects of HIPEC)
The postoperative period requires close follow-up and, in many cases, an initial 24–72 hour stay in ICU. Full recovery may range between 4 and 8 weeks depending on the extent of the surgery performed.
The importance of specialisation
Because of its complexity, cytoreductive surgery should be performed in centres with specific experience in highly complex oncological surgery. Coordination between surgeons, medical oncologists, radiologists, anaesthesiologists and intensivists is essential to deliver a safe and adequate treatment.
Individualised case assessment determines whether this strategy is the most appropriate within the global therapeutic plan. At Quenet Torrent Institute we have one of Europe's reference teams in cytoreductive surgery, led by Dr. Juan José Torrent, with more than 500 procedures performed and results published in international scientific journals. If you wish to have your case assessed, you can contact our team.