Ovarian Cancer Surgery (Staging & Debulking)

Medically reviewed by Dr Manan Boob, MBBS (KEM), MS ObGyn (Gold Medalist), DNB — Consultant Gynaecologist & Laparoscopic Surgeon

What it is

Ovarian cancer starts in the ovary, or in the fallopian tube next to it. For most women the first and most important treatment is an operation. It has two jobs: to confirm exactly what the disease is, and to remove as much of it as can safely be removed. When the cancer looks confined to the ovary, the operation is called staging surgery (staging laparotomy): the diseased ovary is removed and the abdomen is checked carefully for spread. When the disease has already spread within the abdomen, the operation is called debulking or cytoreductive surgery: the aim is to leave as little visible disease behind as possible.

This is one of the larger operations in gynaecology, and it is planned with care. Our wider gynecologic oncology service looks after the whole path, from the first scan to follow-up.

Who needs it

Surgery is advised when scans, blood tests (including tumour markers such as CA-125) and examination suggest ovarian cancer, or when an ovarian mass looks suspicious enough that it needs to be removed and examined. Many women come to me after months of bloating, early fullness, vague pelvic discomfort or a swelling in the abdomen, symptoms that are easily put down to gas or acidity. Others arrive with a cyst found on a scan; most cysts are harmless, and our guide on ovarian cysts, when to worry and when to wait explains how we tell the difference.

For some women with extensive disease or poor general health, chemotherapy comes first and the operation follows once the disease has shrunk. We decide this together after reviewing the scans.

“Is it definitely cancer if you are advising an operation?” Not always. Sometimes the only way to know whether a mass is cancer is to remove it and examine it. That is why the operation is planned so that the diagnosis, and the right extent of surgery, can both be settled in one go where it is safe to do so.

How it is done

You come in fasting, and the anaesthetist puts you to sleep. A tube may be placed in the spine for pain relief after surgery.

The surgeon makes a long cut in the middle of the lower abdomen, so that the whole abdomen can be seen and felt. First, fluid or washings from the abdomen are collected for testing. Then every surface is inspected: the pelvis, the bowel, the liver surface, the diaphragm and the lining of the abdomen.

In staging surgery, the ovaries and tubes, the womb and cervix and the omentum (the fatty apron that hangs over the bowel, a common site of spread) are removed. Small samples are taken from the lining of the abdomen, and pelvic and para-aortic lymph nodes may be sampled. In some cases a more limited operation is possible if fertility matters, as discussed below.

In debulking surgery, the same steps are followed by removal of deposits wherever they sit and it is safe to remove them. Sometimes this means taking a part of the bowel, the spleen’s surface, or the peritoneal lining. If part of the bowel has to be removed, it is reconnected, and occasionally a temporary stoma is needed; we discuss this with you beforehand wherever we can foresee it.

Everything removed is sent for detailed examination. That final report decides what comes next.

Anaesthesia, duration and hospital stay

The operation is done under general anaesthesia, usually with an epidural or other pain-relief technique.

Staging surgery takes about three to four hours. Debulking surgery can take considerably longer, depending on how far the disease has spread, and some women need monitoring in the intensive care unit afterwards.

The hospital stay is usually five to eight days for staging surgery, and longer after extensive debulking.

Recovery

Day 1. Soreness, tiredness, a drip, a catheter and sometimes a drain. We start sips of water as soon as it is safe, get you sitting up and standing early, and give regular pain relief. Breathing exercises and early walking lower the risk of chest infection and clots in the legs.

The first week. Food is built up gradually as the bowel wakes up. The catheter and drains come out when they are no longer needed. Walking gets longer each day.

Weeks 2 to 4. You are at home, tiring easily, with no lifting or straining. The wound is checked and the final biopsy report is discussed. Planning of any chemotherapy begins, usually a few weeks after surgery.

By six weeks. Most women are back to light routine work. Follow-up visits and tests continue for years; they are part of the care, not a sign that something is wrong.

Call us sooner for fever, wound redness or discharge, persistent vomiting, a swollen tender abdomen, calf pain or swelling, breathlessness, or trouble passing urine.

Why open surgery rather than keyhole

For most cancers of the womb, keyhole surgery is our usual choice. Ovarian cancer is different. It spreads by shedding cells across the lining of the abdomen, and the surgeon needs to see and feel the whole abdomen, including areas that keyhole instruments cannot reach reliably. An open incision gives that access, and complete removal of visible disease is the single most important goal of the operation.

That said, keyhole surgery still has a place: to look inside and take a biopsy before deciding on treatment, and occasionally for carefully selected early disease. We tell you which route we recommend for you, and why.

Risks and complications

This is major surgery, and you should hear the risks plainly.

• Bleeding during or after the operation, sometimes needing a blood transfusion.
• Infection in the wound, the abdomen, the chest or the urine.
• Injury to the bowel, bladder or ureter, uncommon, and usually noticed and repaired at the time.
• Bowel problems. A slow-moving bowel after surgery is common; a leak from a bowel join is rare but serious, and may need further surgery or a temporary stoma.
• Blood clots in the legs or lungs. We lower the risk with early walking, stockings and blood thinners where needed.
• Wound problems, including a hernia in the scar later on.
• Early menopause, since the ovaries are removed. We discuss this and how to manage it.
• Incomplete removal. Sometimes disease is too widespread or involves vital structures, and some of it has to be left behind. Chemotherapy is then even more important.
• Anaesthetic risks, which the anaesthetist will discuss with you separately.

Alternatives

Chemotherapy first (neoadjuvant chemotherapy), followed by surgery, is a well-recognised option when the disease is extensive or when a woman is not fit for a major operation straight away. Not everyone is suitable, and the scans guide the choice.

Fertility-sparing surgery. For a small number of young women with very early, low-risk disease who want to have children, removing only the affected ovary and tube, with careful staging, may be possible. It needs close follow-up and a frank talk about the risks.

Genetic counselling and testing may be suggested, because some ovarian cancers run in families. This can guide treatment and help relatives.

There is no non-surgical substitute for the operation in most cases, but chemotherapy, targeted tablets and follow-up are all part of the overall plan, which we coordinate with the oncology specialists.

What it costs

The figures below are all-inclusive — surgeon’s fee, operation theatre, anaesthesia, room rent for a typical stay, medicines and routine investigations.

Open staging laparotomy, early stage: ₹75,000 – ₹1,00,000.

For cytoreductive (debulking) surgery we do not publish a figure, and I would rather say so honestly than guess. The cost varies a great deal with how long the operation takes, whether other organs such as the bowel are involved, whether intensive care is needed, how many days you stay, and the type and number of consumables used. Once we have seen your scans and reports, we can give you a written estimate for your own case. Please call us.

Please note: The figures above are indicative estimates for a typical case. The final cost depends on your individual condition, the complexity of the surgery, the room category you choose, how long you stay, and any complications that arise. Deluxe and super-deluxe rooms are charged higher. Emergency admissions and night or holiday surgery attract additional charges. These charges are subject to change without prior intimation. Please call us on +91-8668954915 for a written estimate for your own case before you decide anything.

Preparing for your surgery

• Bring every report: scans, CA-125 and other blood tests, biopsy or fluid reports, and a list of your medicines.
• Tell us about diabetes, high blood pressure, thyroid, heart or lung problems and any blood thinners. Please do not stop anything on your own.
• Mention any earlier abdominal operations.
• Expect extra tests before surgery, such as a CT scan, blood work and a heart check, and sometimes a bowel preparation.
• Nothing to eat for six hours and nothing to drink for two hours before surgery, unless told otherwise.
• Stop smoking or chewing tobacco as early as you can; it helps healing and breathing.
• Arrange an attendant to stay with you and help at home for the first few weeks.
• Bring someone you trust to the consultation. It is hard to take everything in alone.

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If you or someone in your family has been told there is a mass in the ovary, bring the reports and let us go through them together, unhurried. The gynaecology and laparoscopy team at Shubham Hi-Tech Hospital, Amravati, will explain what is known, what is not yet known, and the next step. Call +91-8668954915 or get in touch here, or see all the procedures we perform.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.