Gynecologic Oncology Program

Ovarian Cancer Surgery

The goal of surgery for ovarian cancer is to remove all evidence of visible cancer from the abdominal and pelvic spaces, even when the disease has appeared to have spread outside of one or both ovaries. Numerous studies have demonstrated that survival is significantly improved when ovarian cancer surgery is performed by specialized surgeons called Gynecologic Oncologists because these surgeons are trained in the complex procedures required to remove ovarian cancer and its metastases. Surgery for ovarian cancer is performed through a vertical incision in the center of the body. This incision typically extends from just above the pubic bone to several inches above the naval. If a Gynecologic Oncologist discovers an ovarian cancer that does not appear to have spread past the ovary (ies), he/she will then map out the disease through a staging operation which is carried out with numerous biopsies which the pathologist will then study to look for microscopic spread of the cancer that was not detectable by the naked eye during surgery. A patient may remain hospitalized for several days following ovarian cancer surgery.

Total abdominal hysterectomy with bilateral salpingoophorectomy (removal of the uterus, ovaries and fallopian tubes)

In this phase of an ovarian cancer operation, the entire uterus, cervix, fallopian tubes, and ovaries are surgically removed from the pelvis. Because the fallopian tubes, uterus, and ovaries are directly connected to each other, it is important for surgeons to remove these structures to help reduce the risk of leaving behind cancer cells.

Omentectomy, pelvic & para-aortic lymphadenectomy, peritonectomy, and evacuation of ascites (removal of the omentum, lymph nodes, affected peritoneal lining of the abdominal and pelvic cavities, and ascites fluid)

This phase of an ovarian cancer operation is directed at those internal structures and tissues that typically serve as sites for ovarian cancer metastases. The omentum is a fatty apron of tissue that is attached to the lower part of the stomach and part of the colon. It is known to soak up ovarian cancer cells and often becomes caked with tumor implants. Similarly, the drainage pathways from the ovaries lead to lymph nodes in the pelvis and along the large blood vessels in the abdominal cavity (abdominal aorta and inferior vena cava). Lymph nodes are glands that serve as filters for different organs and the lymph nodes that drain the ovaries can serve as satellite sites for cancer cells. The inner lining of the abdomen and pelvis is called the peritoneum and these surfaces can become extensively involved by ovarian cancer spread. Removal of the omentum, lymph nodes, and peritoneal surfaces is not detrimental to the health of patients as these structures do not perform any life-preserving functions. Finally, the fluid made by ovarian cancer often gives patients a sense of abdominal bloating. All of this fluid is drained from the patient's body during surgery.

Evaluation of Other Organs

Gynecologic Oncologists will carefully examine all other organs in the abdominal and pelvic cavities to make sure the disease has not spread to involve one or more of these structures. Among the organs evaluated are the stomach, small intestine, appendix, colon, rectum, bladder, spleen, pancreas, gall bladder, and diaphragm. If cancer is discovered to involve these areas, the Gynecologic Oncologist will often choose to remove the affected parts so as to ensure that the patient is not left with any visible cancer at the end of the operation. In the great majority of cases, even if parts of the intestine or colon have to be removed, patients can expect to have normal bowel function after they have healed.

Adnexal Mass Surgery

An adnexal mass is an abnormal growth involving one or both ovaries. When the suspicion for cancer is low, doctors may choose to remove these masses using laparoscopy. Laparoscopic surgery is a form of minimally invasive surgery which requires between two - four very small incisions in the abdominal wall. One incision is to insert a camera along with a CO2 gas line which allows the abdominal cavity to be inflated so that the surgeon can visualize the important structures and have room to operate using laparoscopic instruments which are inserted through the other small incisions. Usually, either the cyst alone or the entire ovary can be removed laparoscopically. The majority of patients who undergo laparoscopic surgery can be discharged from the hospital on the same day of surgery and return to normal activities within two weeks.