What is radical surgery for ovarian cancer?
80% of patients with ovarian cancer are diagnosed with disease outside the ovaries, spread by the peritoneum of the abdominal and pelvic cavity. The peritoneum is a thin layer of cells that internally covers the abdomen and pelvis. Currently, the complete removal of the disease at the time of surgery is the only modifiable prognostic factor in this group of women. However, this means that multiple surgical procedures must be performed in the same operative act and in the same patient. These include: the removal of the uterus and ovaries, and lymph nodes of the pelvis and abdomen. In addition, depending on the distribution of the disease in each patient, a resection of the intestine, surgery on the diaphragm, the liver, the spleen, etc. may be required. Therefore, to perform this type of surgery properly, requires a specialized training of the surgical team. Multiple studies in the world have shown that life expectancies can be extended up to 30% when surgeries are performed by gynecologic oncologists instead of general gynecologists or general surgeons.
The surgical team consists of:
- Gynecologists oncologists
- General gynecologists
- General surgeons
- Operating room nurses
How can patients with advanced ovarian cancer be cured?: Radical debulking surgery for ovarian tumors in advanced stages
About 70-80% of patients are diagnosed with macroscopic disease outside the pelvis. The surgery of the maximum effort consists of extirpating ALL the visible disease in the abdominal and pelvic cavity.
This surgery includes the following procedures:
- Hysterectomy: removal of the uterus, including the cervix.
- Bilateral adnexectomy: this procedure accompanies the previously described and consists of the removal of both ovaries and tubes (uterine annexes).
- Omentectomy: removal of a fatty tissue attached to the large intestine
- Pelvic and para-aortic lymphadenectomy: removal of the lymph nodes around the main arteries and veins of the abdomen and pelvis.
- Appendectomy: extirpation of the appendix in selected cases of ovarian cancer (mucinous histological variant)
- Sometimes, these types of surgeries usually include more complex procedures such as: radical removal of the peritoneum, bowel resection, surgery on the diaphragm and liver, or splenectomy (removal of the spleen). As of today, this surgical approach, although aggressive, represents the only modifiable prognostic factor that improves life expectancy.