This is a surgery in which the volume of tumor tissue is reduced. Cytoreductive surgery not curative surgery, in which one would be removing entirely all tumor tissue.

Now, in ordinary malignancies, there's not that much of a role for cytoreductive surgery. But with neuroendocrine tumors-particularly carcinoid, which tend to be slow-growing-debulking these tumors, even though their total eradication is not accomplished, will reduce the production of hormones. And many of the symptoms that result from these hormones that adversely affect the quality of life will be reduced and may stay palliated for a long time. So there is a role for cytoreductive surgery.

There have been statistics collected that clearly show longer survival, as well as improved quality of life, when tumors have been reduced in volume, though not totally eradicated. There are various ways of carrying on cytoreductive surgery. One, it may simply be surgical excision of a tumor or of metastases. Two, it may simply be the destruction by radiofrequency ablation or cryoablation. And then, also, it comes under the heading of surgical procedure; the destruction of tumors by hepatic artery chemoembolus injection will also affect cytoreduction, debulking of tumors and reduction in hormones being produced.

Sometimes, some of the tumors are not producing large amounts of hormones or not causing an endocrine syndrome, but nonetheless are causing problems, because of their bulk. For example, they can obstruct bile ducts, causing jaundice, or obstruct vena cava, causing venous obstruction. Thus, the reduction of tumor mass may alleviate pressure and the symptoms that are resulting from that.

In addition, in carcinoid syndrome where a late but very serious complication of hormone production is cardiac valve lesions, reduction of hormone production by debulking tumors will help to inhibit or deter progression of the cardiac lesions. When coupled with medical treatment to inhibit hormone production or to regress tumors, the combination is exceedingly useful and will continue to be so.

Richard Warner MD