Ovarian Cancer Surgery

When surgery is possible

In early cancer confined to the ovaries, surgical staging is performed: removal of the uterus, tubes and ovaries and the greater omentum, peritoneal washings and biopsies and, when indicated, removal of the pelvic and para-aortic lymph nodes. It is important to remove the tumor without rupturing its capsule.

In advanced cancer there are two paths, and the tumor board chooses between them based on CT, laparoscopy and general condition:

• primary cytoreduction — if all visible tumor can be removed and the patient’s condition allows it, treatment starts with surgery;
• interval cytoreduction — if complete cytoreduction is not possible at the start or the patient’s condition does not allow major surgery, 3 cycles of chemotherapy are given first, the response is assessed and, if there is no progression, the possibility of complete cytoreduction and the patient’s readiness for surgery are evaluated.

The disease itself, its symptoms and tests are described on the page “Ovarian Cancer”.

If surgery is not possible right now

Treatment is based on chemotherapy with platinum drugs and taxanes; after it the response is assessed and surgery is discussed again. After chemotherapy it is important to reassess whether surgery is possible.

At a first recurrence that occurs late after platinum treatment, secondary cytoreduction is possible in selected patients — when general condition is good, the first operation was complete and there is a chance to remove everything again. Other recurrences are treated with systemic therapy. If you have been told that surgery is impossible, it makes sense to show current images for a surgeon’s second opinion.

Types of ovarian cancer surgery

In carefully selected young patients with early low-risk cancer, the uterus and the other ovary can be preserved after complete staging. In advanced cancer fertility-sparing surgery is not indicated.

How the operation is performed

Cytoreduction is performed through a midline incision: the uterus with the tubes and ovaries, the greater omentum and all visible tumor deposits are removed — when needed together with sections of the peritoneum (peritonectomy), the bowel, the spleen and the surface of the diaphragm. The aim is to leave no visible tumor. Lymph nodes that are not enlarged on CT and during surgery are not systematically removed in advanced cancer.

In some patients HIPEC is considered during interval cytoreduction — rinsing the abdominal cavity with a heated chemotherapy solution right after the tumor has been removed. HIPEC is not a first-line standard: whether to use it is discussed individually by a tumor board. More about this method is on the page “Peritoneal Carcinomatosis”.

In selected cases early staging, when the tumor is confined to the ovary, can be performed laparoscopically, avoiding rupture of the tumor.

Hospital stay, recovery and further treatment

Recovery follows the enhanced recovery (ERAS) protocol: early mobilization, early eating, controlled pain relief. After major cytoreduction the hospital stay is longer, and the first days may require the intensive care unit; sometimes a temporary stoma is created while the bowel heals.

After recovery, usually within the first 6 weeks after surgery, chemotherapy is started or continued. After a response to it, maintenance therapy is discussed taking into account the BRCA/HRD test and the stage. In premenopausal patients removal of the ovaries causes surgical menopause; we talk about its symptoms before surgery.

For the first 2–3 years check-ups, usually with CA-125, take place every 3–4 months, then less often; CT is done for symptoms, a rise in CA-125 or on the schedule set by the doctor.

Risks and complications

Risks are what patients ask about least often, although they are the most important thing to discuss before surgery. The larger the extent of cytoreduction, the higher they are. The main ones are:

• bowel complications — if a section was removed: anastomotic leak, which is why a temporary stoma is sometimes created;
• bleeding during or after surgery;
• infection and general surgical complications, including thrombosis;
• surgical menopause in premenopausal patients after removal of the ovaries.

The likelihood of each depends on the extent of surgery, prior chemotherapy and general condition. I will explain the risks in your particular case at the consultation.

What the cost depends on

The cost depends on the extent of cytoreduction — whether parts of the bowel, peritoneum or other organs are removed — on whether HIPEC is indicated, the number of days in the hospital, including intensive care, and the tests. The exact amount is named once the treatment plan has been defined. The payment can be split into parts — installments are available. The in-person consultation is free. More details are on the page “Cost of Surgery: What It Depends On”.

What documents are needed and how to book

• pelvic ultrasound reports, CT or MRI discs with the reports;
• CA-125, HE4, CEA, CA 19-9 test results;
• the histopathology report and tissue blocks with slides, if a biopsy or surgery has already been done;
• the operative report of previous surgery and the discharge summary;
• the BRCA test result, information about ovarian and breast cancer in the family;
• chemotherapy summaries, if treatment has already started.

Book a consultation by phone or through the form. If you are from another city, send the documents in advance — how to do this is described on the page “Online Oncologist Consultation”.