Surgery is the cornerstone of treatment for ovarian, fallopian tube, and peritoneal cancer at Memorial Sloan Kettering. It’s used for women with early and advanced disease, as well for women whose cancer has come back after treatment.
We use various surgical tools and techniques to:
Since we individualize our approach, what we recommend for you will depend on several factors including the stage of your cancer.
Types of Surgery
For what appears to be early stage cancer, when a tumor is still only in the ovary and hasn’t spread, an option is to undergo a traditional open surgery through a relatively large incision in the abdomen, called a laparotomy. But in many cases we recommend a minimally invasive laparoscopy procedure that’s done through relatively smaller incisions in the abdomen.
Laparoscopy is used to explore the abdomen for cancer, evaluate the extent of the disease, drain any fluid build-up in the abdominal area, retrieve small samples of the abnormal tissue to perform a biopsy, remove a tumor, or determine if a woman might benefit from debulking and chemotherapy. To perform laparoscopy, we insert a small video camera into the abdominal area through an endoscope (a device with a light at the end), and the surgical team guides the camera within the body.
Both laparotomy and laparoscopy are also used to diagnose problems such as ovarian cysts, and fibroids.
Our experts sometimes consult with MSK thoracic surgeons to use a minimally invasive VATS for help in diagnosing and treating ovarian cancer. In this procedure, we insert a tiny video camera into the abdominal area through an endoscope (a device with a light at the end). This way, we can explore the region, identify potential tumors, and remove tissue for biopsy. We can also use VATS to evaluate the extent of disease, drain any fluid build-up in the abdominal area, and select women who might benefit from minimally invasive debulking (cytoreduction).
Our specially trained surgeons often perform robotically assisted minimally invasive surgery to biopsy or treat early stage ovarian cancer. To perform robotic surgery, the surgeon uses finger and foot controls, and the robot precisely copies his or her every movement. The surgical team at the bedside monitors you throughout the procedure, assisting as necessary. Studies suggest that women experience less postoperative pain, recover faster, and have good cosmetic results with this minimally invasive approach.
If cancer has spread beyond the pelvis, MSK surgeons will attempt to remove all the affected tissue during surgery. Depending on what we find, we may need to take out parts of the diaphragm (the thin muscle below the lungs and heart that separates the chest from the abdomen), and segments of the bowel, the spleen, and parts of the liver.
With an approach called debulking, also known as cytoreduction, we remove as much ovarian tumor tissue as possible to boost the effectiveness of chemotherapy in reaching and destroying cancer. The procedure usually involves removing the ovaries as well as the uterus, cervix, fallopian tubes, and any other areas containing disease tissue. The goal is to leave no visible tumor behind.
Eighty percent of women with ovarian cancer at MSK are “optimally debulked,” meaning the amount of tumor remaining after the procedure is very small (less than one centimeter in diameter). More than half of the women who undergo cytoreduction with our team have all visible tumor removed during their first operation. Studies at MSK and around the world show that removing this volume of cancer tissue has led to improved survival for patients.
Some women who have disease that comes back (recurs) benefit from a second debulking operation, depending on how long the disease has been in remission and in what locations the cancer has returned.
For certain carefully selected younger women, we may consider an approach that preserves fertility by finding ways to keep a normal ovary intact, as well as the uterus. As long as the cancer is at a very early stage it’s sometimes possible to remove only the affected ovary (called unilateral ooophorectomy) and fallopian tube, preserving other pelvic organs necessary for fertility. Ask your doctor about the options that may be available to you.