Which factors are used to determine the appropriate surgical approach to the treatment of ovarian cancer?

Updated: Aug 10, 2020
  • Author: Andrew E Green, MD; Chief Editor: Yukio Sonoda, MD  more...
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Answer

The appropriate surgical approach varies, depending on whether disease is visible outside the ovaries. For patients with no disease visible outside the ovaries, adequate surgical staging is essential because the incidence of microscopic metastases is significant. Surgery for patients with stage IV disease should be individualized, particularly when disease is in the liver and above the diaphragm. Patients who are in stage IV because of small-volume disease in the liver, abdominal wall, or thorax can be considered for cytoreductive surgery if medically fit.

If the patient does not desire future fertility, perform a total abdominal hysterectomy and excise the opposite ovary. Appendectomy can be performed if a mucinous tumor is present.

If macroscopic disease is visible outside of the ovary, all visible tumor should be removed. This may require extensive surgery, including bowel resection, excision of peritoneal implants, liver resection, omentectomy, and splenectomy.

The extent of bowel resection should depend on the role this plays in achieving maximal cytoreduction.


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