Page 5 - Guidelines Ovarian Surgery

SURGICAL MANAGEMENT FOR STAGE I-II OVARIAN CANCER
(ALGORITHMS 1-2)

Midline laparotomy is recommended to surgically manage early ovarian cancers. Apparent

B stage I could potentially be managed laparoscopically by a gynaecological oncologist with the
appropriate expertise able to perform an adequate surgical staging laparoscopically. Rupture of

an intact primary tumour with spillage of tumour cells at the time of dissection and extraction

of the specimen should be avoided.

B Intraoperative rupture of a yet-unruptured adnexal mass should be avoided.

The availability of frozen section may allow the necessary surgical assessment to be completed

B at the time of initial surgery. It is understood that frozen section may not be conclusive and

that definitive pathology is the gold standard of diagnosis.

✓ In the absence of frozen section or in the case of an inconclusive frozen section, a two-step
procedure should be preferred.

✓ Total hysterectomy and bilateral salpingo-oophorectomy are standard.

C Fertility-preserving surgery (unilateral salpingo-oophorectomy) should be offered to selected
premenopausal patients desiring fertility3.

B Laparoscopic restaging is an acceptable approach if performed by a gynaecologic oncologist

with adequate expertise to perform a comprehensive assessment.

✓ Visual assessment of the entire peritoneal cavity is recommended.

C Peritoneal washings or cytology, taken prior to manipulation of the tumour, are recommended.

C When no suspicious implants are found in the pelvis, paracolic areas, and subdiaphragmatic
areas, blind peritoneal biopsies are recommended.

C At least infracolic-omentectomy is recommended.

B Bilateral pelvic and para-aortic lymph node dissection up to the level of the left renal vein (with
the exception of stage I expansile type mucinous adenocarcinomas) are recommended.

✓ When early carcinoma is incidentally found at surgery for a suspected ‘benign’ condition,
second surgical procedure will be required when the patient has not been comprehensively
staged.

✓ Reassessment for the only purpose of performing appendectomy is not mandatory even in case
of mucinous histology if the appendix has been examined and found normal.

3 Discussion on fertility must be mentioned in the patient record; final decision is made after comprehensive staging surgery based on 5
final stage and grade: fertility preservation is accepted in case of stage IA or IC1, low-grade serous or endometrioid carcinoma, or
expansile type mucinous tumours; other stage I substages or pathologic subtypes, subject to individualised decision; uterine preservation
with bilateral salpingo-oophorectomy can be considered in selected young patients with apparent stage IB low-risk invasive carcinoma
and normal endometrial biopsy finding, but this is not standard management, and there are few data to support this policy.

• OVARIAN CANCER SURGERY - GUIDELINES •