Surgery for ovarian cancer

Yes, especially when complete cytoreduction is achieved, that is, when no visible disease remains at the end of the operation. That is the factor with the greatest influence on survival in advanced ovarian cancer, more than the initial extent. Surgery is always combined with systemic treatment.

In many cases, yes. So-called interval surgery, performed after several cycles of neoadjuvant chemotherapy, is a common and effective strategy in extensive disease. Chemotherapy shrinks the tumor and allows complete cytoreduction with fewer complications than operating first.

It is hyperthermic intraperitoneal chemotherapy: it is given heated, directly into the abdomen, during the operation itself. It acts on microscopic cells that surgery cannot see. In ovarian cancer, the benefit has been shown mainly in interval surgery after neoadjuvant chemotherapy.

In very selected cases of early stage and low grade disease, conservative surgery that preserves the uterus and the healthy ovary may be considered. It requires complete surgical staging to confirm that the disease really is confined, and a joint assessment with oncology and the fertility unit.

Those of major abdominal surgery: bleeding, infection, leakage at the bowel joins if part of the intestine is resected, and thromboembolic complications. Extensive cytoreduction adds the risk of multiple resections. At specialized centers, mortality and serious complications are significantly reduced.

The hospital stay is usually 7 to 14 days and full recovery takes between 2 and 3 months, depending on the extent of surgery. Chemotherapy afterwards affects that timeline. Enhanced recovery protocols, with early mobilization and nutrition, shorten the stay.

In selected cases a second cytoreduction may be considered. The patients who benefit are those with platinum-sensitive recurrence, localized disease and good general condition, the profile identified by the AGO criteria and confirmed by the DESKTOP III trial. Outside that profile, treatment relies on chemotherapy.

In very selected cases of early stage disease, or for specific procedures such as staging or an assessment laparoscopy. In advanced disease with carcinomatosis, open surgery is still the approach that allows the whole abdominal cavity to be examined and treated, which is what determines the result.

It is advisable, especially if you have been told the disease is not operable or if the plan does not include complete cytoreduction. In advanced ovarian cancer, the criteria for operability vary widely between centers, and that difference translates into different results for the same patient.

At centers with proven experience in advanced ovarian cancer surgery and in peritoneal surgery. It is worth asking what complete cytoreduction rate the team achieves and how many cases it treats each year. That figure predicts the result far better than the technology available.