Surgery for Ovarian Cancer

Yes, particularly when complete cytoreduction is achieved, meaning no visible disease is left at the end of the operation. That is the factor with most influence on survival in advanced ovarian cancer, ahead of how extensive the disease was at diagnosis. Surgery is always combined with systemic treatment.

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

It is hyperthermic intraperitoneal chemotherapy: heated chemotherapy delivered directly into the abdomen during the operation itself. It acts on the microscopic cells surgery cannot see. In ovarian cancer the benefit is established above all in interval surgery, after neoadjuvant chemotherapy, and always on a complete cytoreduction.

In highly selected cases at a very early stage and low grade, conservative surgery preserving the uterus and the healthy ovary can be considered. It requires a full surgical staging to confirm the disease really is confined, and joint assessment with oncology and the fertility unit before proceeding.

Those of major abdominal surgery: bleeding, infection, a leak at the bowel join if intestine is resected, and thromboembolic complications. Extensive cytoreduction adds the risk inherent to multiple resections. In specialist centres, mortality and severe complications are significantly lower than in low-volume units.

The hospital stay is usually 7 to 14 days and full recovery takes two to three months, depending on how extensive the surgery was. Any chemotherapy that follows shapes that timetable. Enhanced recovery protocols, with early mobilisation and early nutrition, shorten the stay and reduce complications.

In selected cases a second cytoreduction can be considered. The patients who benefit are those with platinum-sensitive recurrence, localised 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 highly selected cases at an early stage, or for specific procedures such as staging or an assessment laparoscopy. In advanced disease with carcinomatosis, open surgery remains the approach that allows the whole abdominal cavity to be inspected and treated, and that is what determines the outcome.

It is advisable, above all if you have been told the disease is inoperable or if the plan does not include a complete cytoreduction. In advanced ovarian cancer the criteria for operability vary widely between centres, and that difference translates into different outcomes for the same patient.

In centres 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 outcome far better than the technology on offer.