Surgical Treatment

Purposes of surgical treatment:

  • Staging
  • Debulking
Common Surgical Procedures for Epithelial Ovarian & Germ Cell Tumors
Surgical Procedure Description/Structures Removed
Salpingo-oophorectomy (SO) Fallopian tube (FT) & ovary
       Unilateral SO

FT & ovary on one side

When preservation of fertility desired

       Bilateral SO FT & ovary on both sides
Total Hysterectomy (TH) Uterus & cervix
Lymphadenectomy Lymph node dissection
       Regional Regional lymph nodes
       Radical Most to all lymph nodes
Omentectomy Omentum (fibrofatty sheet overlying abdominal organs)
Cytoreductive Debulking

May involve TH, SO, omentectomy, peritoneal wall resection, removal of colon (colectomy), bladder resection (cystectomy), and removal of other abdominal organs.

Optimal if all visible cancer & tumors >1 cm are removed

Pelvic Washing Abdominal cavity is rinsed & fluid sent for cytopathological assessment

Surgical Procedures according to Clinical Stage

From the National Comprehensive Cancer Network (NCCN) Guidelines Version 2.2018 [18]:

Tumor Involvement or Patient Status Approximate Stage Applicable Surgical Procedures
Tumor is confined to the ovaries or pelvis

Stages I-II

  • Bilateral or unilateral Salpingo-oophorectomy (fertility desired)
  • Hysterectomy
  • Omentectomy
  • Para-aortic lymph node dissection
Tumor involves the pelvis and upper abdomen Stages III-IV
  • Omentectomy
  • Para-aortic and bilateral pelvic lymph node dissection
  • Cytoreduction (which can include, but is not limited to: appendectomy, splenectomy, partial cystectomy and/or ureteroneocystostomy, etc.)
Debulking after neoadjuvant chemotherapy Stage IV
  • Cytoreduction
  • Debulking (including total abdominal hysterectomy and bilateral Salpingo-oophorectomy) after ≤4 cycles of neoadjuvant chemotherapy
  • Omentectomy
  • Lymph node resection
Risk-reducing Salpingo-oophorectomy protocol – applicable to those with genetic/familial risk characteristics N/A
  • For more information on when the risk-reducing protocol is appropriate, see the NCCN Guidelines

Updated: June 8, 2018