Surgery for Ovarian Cancer: What to Expect

For many women diagnosed with ovarian cancer, the initial recommendation will be to undergo minimally invasive surgery as a first step in treatment. This type of surgery is a way for doctors to fully determine the stage of the disease, and to collect tissue samples to make the actual diagnosis. Surgery is not always a first step particularly during the COVID-19 pandemic when doctors need to weigh potential risks of surgery.

“Minimally invasive surgery allows us to assess the stage of the disease, where disease is present and where it’s not,” says Daynelle Dedmond, gynecologic oncologist with Centura Health. A slender, lit camera called a laparoscope may be used to examine the organs in the abdomen and pelvis to investigate the extent of the cancer. “It’s also helpful to be able to get a biopsy of the actual tumor, which can’t always be done without surgery.” Dr. Dedmond explains that doing an initial, minimally invasive procedure can be a good initial approach, “even if we’re not sure that we’ll be able to complete an entire surgical debulking [removing as much of the tumor as possible] in that operative setting.”

If a laparoscopic evaluation determines that an optimal debulking surgery is possible, “then the incision would be made and the full surgery would be completed,” Dedmond says.

There are certain cases where less extensive robotic surgery—where doctors make a series of small incisions around the belly button rather than a larger one down the abdomen midline—might be appropriate to remove cancerous growths. For instance, in patients whose disease is focused in the pelvis, rather than spread throughout the abdomen.

Unfortunately, robotic surgery isn’t an option for every woman with ovarian cancer, since many patients have disease that is too diffuse for the robotic platform to achieve the same results as doctors can get through an open incision.

The more extensive debulking surgery generally starts with a complete hysterectomy, which involves removing the uterus, fallopian tubes, ovaries, cervix. Surgeons also remove the omentum–an apron of fatty tissue that covers and supports the intestines and organs in the abdomen–because ovarian cancer sometimes spreads to this area. Doctors then check the diaphragm, and bit by bit go over each and every organ and try to remove any tumors that they may see. Though ovarian cancer does form some balls of tumor, it has a tendency to coat other areas.

Debulking surgery is often very lengthy—”removing every [visible] area of disease possible can take up to six to eight hours,” Dr. Dedmond says. “That’s really our goal as gynecologic oncologists: to provide a patient with an optimal surgical debulking, which means that no evidence of disease that we can feel or see is left behind.”

This attention to detail is crucial, as patients whose tumors have been optimally debulked have a better prognosis than those left with larger tumors after surgery.

Learn more about SurvivorNet's rigorous medical review process.