Ovarian Cancer Surgery: How Doctors Decide on Treatment Options

The type of surgery you'll have generally depends on the stage of your disease and how widely the cancer has spread. "Frequently, [we operate] through a midline [abdominal] incision," says Dr. McHale. "That's [so we're able to] explore everything from the diaphragm, which sits just below the lungs, all the way down to the pelvic floor, where the uterus, fallopian tubes, ovaries and the bladder are. We'll examine everything within that boundary for signs of diseasethe small and large intestine; the surface of the liver and the stomach; the omentum, which is a richly vascular fat pad that hangs from the stomach. Our goal is to remove all visible disease at the time of surgery."

The medical term for this procedure is "cytoreductive surgery," or debulking surgery, and it's especially important if the cancer has spread throughout the abdomen. The aim of debulking surgery is to leave behind no visible cancer, or no tumors larger than 1 cm (less than 1/2 an inch). This is called optimally debulking the tumor. Patients whose tumors have been optimally debulked have a better prognosis than those left with larger tumors after surgery.

Minimally invasive surgery may be an option for some women who are diagnosed with early-stage, localized ovarian cancer (meaning the cancer has not yet spread beyond the ovaries). Or for patients whose ultrasound or CT scan shows a mass, but there’s not enough information from the imaging study or clinical examination for doctors to know whether the mass is malignant or not.

A minimally invasive procedure may also be used as a diagnostic toolto determine the "stage" of the disease, to collect tissue samples, remove lymph nodes, get a biopsy of the tumor. Doctors can’t always make the actual diagnosis of ovarian cancer without these steps. In this type of diagnostic procedure, a slender, lighted tube with a camera called a laparoscope is used to examine the organs in the abdomen and pelvis to investigate the extent of the cancer and assess whether a less invasive surgical approach is appropriate, or if a laparotomyabdominal surgery requiring a full incisionwith surgical debulking would be more successful.

The benefits of minimally invasive surgery include less bleeding, a shorter hospital stay, and quicker recovery time, points out Dr. McHale. Unfortunately, it's not always the best surgical approach for ovarian cancer. That's because many patients have disease that is too widespread to achieve the same results through small incisions as doctors can get with an open surgery.

As one oncologist told SurvivorNet, "Oftentimes, minimally invasive surgery prevents us from being able to see in the nooks and crannies in the upper abdomen, behind the liver and the spleen, and other areas that are difficult to assess unless you actually have your hand in there." So while the appeal of a less invasive, shorter procedure is, of course, understandable, for many women with ovarian cancer a more traditional open surgery will offer the best prognosis.

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