Cytoreductive Surgery

Cytoreductive surgery is a procedure to remove cancer that has spread to the peritoneal (abdominal) cavity. It is performed on patients with peritoneal carcinomatosis (cancer that has spread within the abdominal cavity) to remove all visible signs of cancer. 

The most common cancers that need this type of surgery include:


Cytoreductive involves removing any visible tumours in the abdomen, which may include involved organs. The extent of surgery will be determined by the amount of tumour in your abdomen and chest. You will receive a thorough consultation by Dr. Tranoulis in order to carefully balance the risks and benefits of organ removal with your cancer treatment and overall health, and will discuss this with you extensively prior to surgery. Cytoreductive surgery typically removes both ovaries, the uterus, and any cancer nodules found in the abdomen. Dr. Tranoulis may also need to remove: 


  • Part of the lining of your abdominal cavity (peritonectomy)
  • Part of your small intestines or colon (colectomy)
  • Your omentum—the fatty apron hanging from your intestines (omentectomy)
  • Your spleen (splenectomy)
  • The tail of your pancreas
  • Part of the diaphragm (lining of your breathing muscle)
  • Part of the liver (partial hepatectomy)
  • Your gallbladder
  • Part of your stomach
  • Any enlarged lymph nodes
  • If necessary, reconstructive procedures will be performed on abdominal organs to function normally.


Cytoreductive surgery can be performed in the primary setting (primary cytoreductive surgery) followed by 6 cycles of adjuvant chemotherapy. The aim of the cytoreductive surgery is to remove all the visible disease, as this is associated with optimal oncological outcomes.  In some cases, the extent of the disease or the general condition of the patient (e.g., advanced age, serious health problems, poor nutrition) does not allow the above goals to be achieved without a high risk of complications. In such cases, chemotherapy (neoadjuvant chemotherpay) before surgery (interval cytoreductive surgery) is usually administered to shrink the cancer so it can be removed with less extensive surgery. 


For highly selected cases treated in the neo-adjuvant setting, Hyperthermic Intraperitoneal Chemotherapy (HIPEC) can be administered intra-operatively after achieving complete removal of the disease. Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) are two separate procedures that are usually performed together. Cytoreductive surgery removes all visible cancer cells, and HIPEC targets any remaining microscopic cells. HIPEC is administered in the operating room typically after cytoreductive surgery. A heated chemotherapy solution is circulated in the abdominal cavity to treat any cancer cells that may remain. The combination of heat and chemotherapy delivered directly to your abdomen in the operating room is believed to be more effective than interval cytoreductive surgery alone because it can access and kill more cancer cells than can be found with the naked eye.


Dr. Tranoulis will review your case and recommend a treatment plan based on specific details of the disease and your personal factors. It may or may not involve HIPEC. No matter what treatment course he recommends, Dr. Tranoulis will spend as much time as necessary with you and your family, to answer all of your questions. Dr. Tranoulis can help you and your family decide whether cytoreductive surgery with or without HIPEC is a good option for you.  After your appointment, a panel of our cancer specialists (Multidisciplinary Team Meating - MDT) will review your case in order to formulate an evidence-based, personalised plan for your particular situation.


Excellence in Surgical Care


Dr. Tranoulis is highly experienced in the treatment of gynaecological cancers and a recognised leader in his field. International studies have demostrated that surgeons performing higher volumes of particular procedures can often offer patients better outcomes, such as shorter hospital stays and fewer complications. Studies also confirm that ovarian cancer patients initially treated by Gynaecological Oncologists specialised in Cytoreductive Surgery have improved survival rates compared to those treated by general gynaecologists or general surgeons. Cytoreductive surgery is a complicated surgery that should only be performed by highly skilled, experienced surgeons on patients who have been carefully selected for the procedure. Dr Anastasios Tranoulis is a Certified Gynaecological Oncologist  with further sub-specialisation in Cytoreductive Surgery and HIPEC at the prestigious Basingstoke Peritoneal Malignancy Institute and The Pan-Birmingham Gynaecological Cancer Centre

Dr. Tranoulis will carefully review your medical records and meet with you to determine if this operation may be an effective treatment for you. Two factors are critical for successful outcomes: First, careful patient selection to determine who may benefit the most with the least amount of risk, and second, performance of this operation by a Gynaecological Oncologist experienced in the care of complex cancer patients.