Behind the lectern were seven American flags. The sounds of the national anthem and shouts of "USA! USA!" filled the room.

The scene was an auditorium at Drake University in Des Moines, Iowa, where an exuberant crowd awaited Republican presidential candidate Donald Trump. He was not there yet, but the show had already begun - all in front of a large media contingent.

When Trump came out from behind the curtain, it was his state. Less than a week before the Iowa caucuses, he is leading in all the polls.

Across town, the other Republican candidates were facing heated questions in a televised debate. For Trump, there were no tough questions, no counter-arguments, no opponents - only support.

"I support him because he tells the truth, unlike the others," said 68-year-old Ricky Redcliffe, who drove three and a half hours from Minnesota to see Trump.

The debate pitted seven of Trump's main rivals in the Republican race for the presidential nomination.

Ted Cruz, running second in many polls, had to fend off attacks from other candidates, including former Florida governor Jeb Bush, Florida Senator Marco Rubio and Ohio Governor John Kasich.

It was the last televised Republican debate before intra-party voting is held in Iowa on Monday.

Trump made good on earlier threats to drop out, meaning the last major televised debate occurred without the radical candidate who has challenged the US political establishment in unprecedented ways.

Ostensibly, Trump's refusal to participate was about a dispute with Fox News. He clashed with moderator Megyn Kelly during a previous debate, accusing her of showing favouritism to his competitors. Kelly was among the debate's questioners again on Thursday.

Trump stayed away because he was "treated badly," he told his audience. He was not standing centre-stage in the heart of Des Moines, but he still received plenty of adulation.

At Trump's event, which was reportedly cobbled together within 48 hours, the media presence was notable. About 200 journalists and 800 attendees were in the auditorium.

"We have more cameras here than are over there (at the debate)," Trump joked, while complaining how the other candidates are corrupt and let themselves be guided by lobbyists.

Trump invited two fellow Republican presidential candidates, Rick Santorum and Mike Huckabee, to be part of his event.

Neither has a chance of winning his party's nomination - their poll numbers were not high enough to be included in the main debate - but both offered Trump high praise.

There were few references to Trump at the debate, but when Kelly asked about "the elephant not in the room," Cruz attempted to imitate Trump's infamous taunts.

"Let me say I'm a maniac and everyone on this stage is stupid, fat and ugly. And Ben, you're a terrible surgeon," Cruz said in an attempt at humour that fell flat.

With that "Donald Trump portion out of the way," Cruz went on to thank the other candidates for showing respect "to the people of this state and the people of the country."

But Cruz drew boos when he complained about questions that he said invited the other candidates to attack him.

Bush, formerly a favourite in the race, might have profited the most without Trump on the stage. He spoke ironically about his foe: "I kind of miss Donald Trump. He was a little teddy bear to me. We always had such a loving relationship in these debates."

Trump went after Bush in earlier debates, hitting him hard. Without Trump, the debate featured more substance, was less noisy and stuck to topics voters care about.

The dominant themes included foreign policy and the fight against terrorism. But no one managed to fill the void left by Trump.

Cruz, who stood at the centre podium previously occupied by Trump, made an especially nice target for his opponents, who criticized his shifting position on immigration.

Rubio tried to score points with tough talk: "If we capture any of these [Islamic State] killers alive, they are going to Guantanamo Bay, Cuba, and we're going to find out everything they know, because when I'm president, unlike Barack Obama, we will keep this country safe."

Bush made no mistakes, but he also did not shine. Kasich offered himself as a moderate alternative with a successful record running Ohio. Chris Christie, governor of New Jersey, attacked Hillary Clinton, the front-running Democrat, for a scandal over the use of a private email server while she was secretary of state.

Ben Carson, a retired neurosurgeon, is still in the running, but he was so low-key in his demeanor that he did not stand out. Rand Paul, who returned to the main stage because of Trump's absence, landed at least a few sharp punches.

In the end they returned again to the candidate who was not there. When Bush tried to make the point that candidates' words have consequences, he admitted it was a reference to Trump's statement about banning Muslims from entering the country.

"Donald Trump - I mentioned his name, in case anyone missed him," Bush said.

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