Department of Senological, Gynecological, Plastic and Reconstructive Surgery - Paris Professor Fabrice Lecuru - Institut Curie
  • Ovarian cancer - The surgical intervention

    The surgical intervention

    Early stages


    The excision of the tumor generally poses little problem since it requires the removal of one or two ovaries and the fallopian tubes.
    Other gestures are however necessary in order to verify that the disease is indeed limited to the ovary. We systematically perform biopsies of the peritoneum, removal of the omentum (omentectomy), removal of the lymph nodes of the small pelvis (pelvic lymph nodes) and abdomen (aortico-caval lymph nodes) as well as the uterus. These interventions can be carried out by laparotomy, that is to say with the wide opening of the belly, but also by laparoscopy (small incisions, use of a camera and small instruments).

    Conservative treatments


    In certain very selected cases, with biologically less aggressive tumours, an early stage, in young women still wishing to have a pregnancy, it is possible to carry out a treatment preserving the uterus and an ovary. These treatments, when validated by trained teams, make it possible to obtain good results in the treatment of cancer and also good results in terms of subsequent pregnancy. Unfortunately, this treatment only concerns a minority of patients.

    Advanced stages


    The objective of the surgery is to perform the complete excision of the disease. It therefore requires the removal of the 2 ovaries (with the fallopian tubes), the uterus (hysterectomy), the omentum (fatty tissue, located near the stomach: omentectomy), the diseased peritoneum (very often in the flanks or below the diaphragm), but also parts of the colon or small intestine. The lesser pelvic lymph nodes (pelvic lymph nodes) and abdominal lymph nodes (aorticocaval lymph nodes) can also be removed.



    The intervention is preceded by a nutritional assessment and re-nutrition (and pre-habilitation) in the majority of cases.

    These procedures require general anesthesia. It is now combined with epidural anesthesia, which limits post-operative pain.

    Improved rehabilitation protocols, with an adapted anesthesia protocol, limitation of the use of drains, early mobilization, rapid resumption of food, etc. are commonly used to improve post-operative comfort, reduce hospital stay and reduce the risk of post-operative complications.
    After the operation, recovery requires a week of hospitalization, during which fatigue is observed, a resumption of transit and eating, mainly abdominal pain.
    It should be noted that the use of a trained team with a complete technical platform reduces the risk of complications and optimizes care.

    In order to limit the risk of performing an incomplete procedure, a laparoscopy is generally performed before or at the start of the laparotomy. This intervention, carried out under general anesthesia, allows thanks to a camera, introduced by the umbilicus to explore the pelvis and the abdomen and to list the healthy zones and the affected zones. It also makes it possible to take samples which make it possible to determine the precise type of the tumor and therefore to adapt the treatment.

    If the preoperative assessment and laparoscopy show that the disease can be completely removed with an acceptable risk of complications, it is proposed to begin treatment with surgery. Conversely, if the extent of the disease or the condition of the patient does not allow a complete intervention or exposes them to too great a risk of complication, it is proposed to begin the treatment with chemotherapy. The surgery will be performed in a 2nd time.

    Risks of surgery (advanced stages).


    During the procedure, the main risks are bleeding, wounds in the intestine, opening of the diaphragm, wounds in the ureters or the bladder, etc.
    After the intervention, the most frequent complications are intra-abdominal hematomas or in the wall, urinary tract infections or at the level of the scar, but also haemorrhages which may require a new intervention, peritonitis with also a risk of re-intervention, pneumothorax, pleural effusions, etc.
    The frequency of these complications should not be underestimated. It varies from 3 to 25% depending on the type of complication. Blood transfusions are almost compulsory.