Surgical Procedures for Ovarian Cancer

Description of the Procedure

Depending on your situation, your surgical procedure may involve:

• Exploring to identify exactly how advanced the cancer is and how far it has spread
• Removing only the diseased ovary (ovariectomy)
• Removing both ovaries, both fallopian tubes, the uterus, and as much associated tissue as possible (if the cancer has visibly spread to other organs in the pelvis)
• Removing both ovaries, both fallopian tubes, the uterus, and as much associated tissue as possible, as well as any suspicious-looking lymph nodes

For the lesser procedures, an incision will be made across your lower abdomen, through which the ovary or female organs will be removed. The vagina will be sewn closed from the inside in such a way that sexual intercourse will not be hindered.

For more radical procedures, the incision may extend the length of your abdomen. Every lymph node from the diaphragm to the anus will be inspected, and any that might contain cancer cells will be removed. Organs and lymph nodes that are removed will be sent to the pathologist for analysis under a microscope.

Effectiveness

It is often not possible to remove all cancer during surgery, but this depends upon many factors. Among them are:

• Whether the cancer is confined to one ovary and has not broken through the capsule of that ovary
• How intimately and how extensively the cancer has invaded other organs
• How widely the cancer has spread
• Whether there is fluid in the abdomen which contains cancer cells
• How difficult it is to access and remove cancerous tissue
• How easy it is to locate each tumor mass

Possible Complications

Surgery of any kind has its attendant list of complications that includes bleeding, infection, and medication and anesthetic complications. Abdominal surgery adds local complications such as ileus (paralysis of the bowel caused by handling it) and adhesions (scarring that can obstruct the bowel).

Postoperative Care

Expect to spend at least the better part of a week in the hospital after your surgery. Your bowel will need time to recover and handle food; you will need pain medication; the surgeon will want to watch you closely for reactions to medication and signs of bleeding and infection.

Once you leave the hospital you will need a few weeks to regain your strength and heal your incision. Expect to visit your surgeon at least once after surgery and to maintain contact with the doctors who are managing your cancer.

Description of the Procedure

You will most likely be put under anesthesia for the procedure, although it may be done in an outpatient surgical facility rather than a full-function hospital. Small abdominal incisions the size of buttonholes are made in strategic places. Through these are placed a lighted, pencil-thin telescope (laparoscope) and instruments that grab, cut, and cauterize, and pass air, fluids, and tissues. Your abdominal cavity is pumped full of (sterile) gas to allow room for the instruments and for the surgeon to see.

After a thorough look, pieces of cancer tissue will be removed through the instruments for examination (a biopsy). The air will be removed, the incisions closed, and you will be awakened.

Effectiveness

The major limitation of laparoscopic surgery is the inability to access the far recesses of your abdomen and pelvis. Consequently a complete examination is not possible. Laparoscopy is usually adequate for examining the primary organs, in this case the ovaries, and for obtaining biopsy specimens.

Possible Complications

The benefits of laparoscopy are a greatly reduced incidence of complications and shortened hospital stay. The list of complications is essentially the same as for open laparotomy, but their likelihood is less.

Postoperative Care

You may be able to go home the same day. At worst, you will ordinarily stay overnight in the hospital to recover from the anesthetic. You will have a few band-aid sized dressings on your incisions and perhaps some abdominal discomfort for a few days.