Ovarian Cancer Surgery Considerations

A few reasons that surgery may be postponed include:

• Other Medical Issues and Medications

Sometimes surgery needs to be postponed so that other medical issues can be addressed first. Surgery is a stress on the body, which needs to be as strong and healthy as possible before the operation in order to recover well afterwards. Sometimes other medical conditions, even minor ones, need to be addressed before the surgery. There may also be issues with medications, and doctors will need to be sure it’s safe for a patient to stop taking some blood thinners and painkillers before the operation.

• Frailty

Surgeons are becoming more aware of the risks of frailty before surgery. Sometimes it’s the cancer itself that causes frailty, especially in older patients. "We know that there is often a delay in diagnosing ovarian cancer," says Dr. Crispens. "That delay may mean that patients have not been able to eat or drink, they've been slowly wasting away a bit because of the disease." And some older patients may have underlying health conditions which caused frailty well before the diagnosis of ovarian cancer. A nutritious diet, and weight gain if recommended, can help get the body ready for the stress of surgery.

• Ascites

Another reason surgery for ovarian cancer may need to be postponed is a side effect of the cancer called ascitesan abnormal buildup of fluid in the abdomen.  "An older woman may come in with a very distended abdomen from the fluid. She hasn't been able to eat or drink well. Maybe she already wasn't the strongest person," says Dr. Crispens. "In that case, even if the tumor would be relatively easy to resect, we might hold off to give her some chemotherapy, maybe try to reduce the fluid, help her get better nutrition and physical therapy. . . get her strength back so that when she's in the operating room we know she's going to have a good chance of recovery."

Some of the risks posed by ovarian cancer surgery have to do with the type of surgery that's required. Dr. Crispens explains that the risks increase depending on how extensive the surgery needs to be. "If it's a fairly straightforward operationremove the fallopian tubes, ovaries, uterus, omentum [the apron of fat that protects the abdomen]that can be less risky in terms of bleeding or infection or injury to surroudnng structures than a complex pelvic dissection where the cancer may involve the bowel and you might have to do a colostomy."

Once all of these issues have been taken into consideration, the actual preparation for surgery is very straightforward. "It's changed a lot since I was in training," says Dr. Crispen. "It used to be that patients were told to have absolutely nothing to eat or drink after midnight before the surgery. That's no longer the case. Now we understand that it's better for recovery if we don't have patients come into the operating room in a state of starvation." At Vanderbilt, where Dr. Crispens practices, patients are often directed to drink a liquid nutritional beverage"something as simple as Gatorade"in the evening prior to surgery and up to two hours before.

Afterwards, an epidural or local pain block can help minimize postoperative pain. And while hospital policies have changed during the coronavirus epidemic, Dr. Crispens says "ideally we want family to be there to support the patient in this journey." Familial support can help to decrease stress on the body and help speed up recovery after surgery.

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