Surgery for Ovarian Cancer

For patients diagnosed with ovarian cancer during surgery, the first phase of treatment is surgical laparotomy or exploration of the abdomen. For a laparotomy, the surgeon makes an incision down the middle of the abdomen and attempts to remove as much of the cancer within the abdomen and pelvis as possible. The goal of laparotomy is to accurately diagnose and stage the cancer and gain prognostic information that can determine whether additional therapy is necessary.

Patients with stage I disease may have the entire cancer removed and may not need to receive additional treatment. Patients with stage II-IV disease undergo surgical removal of the cancer which includes:

• A total hysterectomy (removal of the uterus)
• Bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes)
• Omentectomy (removal of a flap of fatty tissue covering the bowel in the abdomen)
• And removal of any visible cancer within the abdomen

If the cancer appears to be limited to the ovaries or the pelvis, the surgeon will also cut small pieces of tissue (biopsy) from the upper abdomen, collect abdominal fluid samples and remove lymph nodes so that they can be examined under a microscope to determine whether they contain cancer. These extensive and time-consuming surgeries are best performed by a gynecologic oncologist, who is a surgeon specialized in the treatment of female pelvic cancers.

For patients with metastatic ovarian cancer (cancer detected outside the abdomen), surgery may be beneficial for relief of symptoms and to improve duration of survival. Surgery to remove cancer in the abdomen may help relieve pain, prevent obstruction or blockage of the bowel, and improve a patient's nutritional status.

If the cancer involves only one ovary and the surgery shows no cancer beyond a single ovary; a unilateral salpingo-oophorectomy (removal of one ovary and fallopian tube) can be performed. This allows the patient to bear children and still provides adequate treatment for the cancer. After childbearing is complete, the remaining ovary and the uterus are often removed in an effort to prevent a recurrence.

Patients who undergo laparotomy for ovarian cancer may experience pain in the lower abdomen after the operation. Complications related to surgery may include bleeding, infection, slow recovery of bowel function, temporary difficulty with emptying the bladder or other less common conditions. Your surgeon should explain the risk of side effects associated with treatment.