Ovarian Cancer Surgery – What are the Risks?

“The complications that could arise from surgery for ovarian cancer depend largely on the surgical approach that’s being taken,” says Dr. Amer Karam, gynecologic oncologist at Stanford University. Staging surgeries, for example, tend to come with fewer risks that “debulking” surgeries, which often require removing part of the bowel and other structures in the abdomen.

Staging Surgeries

Ovarian cancer surgery is different for every patient. With surgery, doctors can determine how far your cancer has spread while also removing all signs of disease. But the type of procedure you’ll need isn’t always clear at the time of diagnosis.

If a patient has early stage disease, doctors may be able use a lower-risk, minimally invasive approach, called laparoscopic surgery. “With laparascopic surgery for ovarian cancer, most complications have to do with the areas that are being sampled or removed,” Dr. Karam says. “So, the surgeon has to take care not to injure any of the structures close to the ovaries or the uterus.”

High risk areas include:

• The bladder
• The intestines
• The ureter (the connection between the kidneys and the bladder)
• The blood vessels and nerves that course next to the lymph nodes

Debulking Surgeries

Debulking surgery for ovarian cancer is a complex procedure, and you may be under general anesthesia for several hours. If the cancer has spread to other organs, your doctor will remove as much of it as possible. This technique may require removing portions of the bowel, bladder, stomach, appendix, liver, spleen, or pancreas.

“If a patient has to undergo open surgery for ovarian cancer, the risks are obviously higher,” Dr. Karam says. “For these bigger surgeries, possible complications that can happen during and after the surgery are infections, additional bleeding, and the potential for the areas that were put back together at the time of surgery to break down and leak.”

In fact, up to half of women who undergo surgery for ovarian cancer experience some sort of complication related to the procedure. A few of the most common include:

• Blood transfusion: “Frequently patients lose enough blood during the surgery where they will require a blood transfusion,” Dr. Kamar says. Unfortunately, getting a blood transfusion during surgery can also increase the risk of infection.
• Infection: Infections can be superficial, or they can occur deep within the surgical site. Signs of infection include fever, shivering, cough, and swelling or redness around the wound. Patients who develop an infection after surgery also require longer hospital stays, which can be complicated during the coronavirus pandemic.
• Damage to surrounding structures: People commonly associate ovarian cancer surgery with damage to the bowel or bladder, and the need for an ostomy bag to relieve stool, or a catheter to remove urine.
• Blood clots: Ovarian cancer surgery increases the risk of developing blood clots in your pelvis and legs, which could put pressure on your heart, lungs, and other organs. You can help reduce your risk of developing clots by getting up and out of bed shortly after your operation.

Toward a Successful Outcome

While most ovarian cancer requires extensive surgery, your doctor will perform the procedure that will remove as much disease as possible to increase your odds of a positive outcome. To achieve that goal, patients often require extensive procedures that may result in complications.

The key to avoiding complications, according to Dr. Kamar, hinges not only on the surgeon’s technical experience, but also on which techniques they use to remove disease. “Particularly in the case of advanced stage ovarian cancer, surgeons have to be very meticulous and very systematic in terms of minimizing the risk of complications at the time of surgery,” says Dr. Kamar.

The good news: There are measures doctors put in place to reduce many the risks associated with surgery. You can do your part to reduce your risk of complications and streamline your recovery by following your doctor’s recommendations about staying strong and healthy in preparation for the surgery, and caring for yourself properly afterwards.

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