Exploratory Surgery for Ovarian Cancer: ‘We Don’t Always Know What We’ll Find’

For women who have what appears to be an advanced ovarian cancer (from a review of CT scans and other diagnostics) surgery will likely be an “exploratory laparotomy,” meaning that a doctor will make a midline abdominal incision as compared with smaller incision using a laparoscope. During surgery, the uterus, tubes, and ovaries are removed, along with any additional cancer that is visible. This may include a portion of the large or small intestine.

Once the underlying pathology has been determined, an exploratory laparotomy may continue as a therapeutic procedure; sometimes, it may serve as a means of confirming a diagnosis.

Dealing with the Unknown

"With ovarian cancer surgery, we don't always know exactly what we will need to do, or exactly what we're going to find once we open the abdomen," explains Dr. Kimberly Levinson, Director of Johns Hopkins Gynecologic Oncology at Greater Baltimore Medical Center. "It is very much about [having] to evaluate when we get in. And we have to be prepared for anything."

A surgeon may discover something that they didn’t talk about specifically with a patient. "For instance, [the extent] of how much bowel we may need to remove. For many women, not knowing what to expect is, understandably, one of the hardest parts. “A lot of thought and a lot of consideration goes into that in terms of counseling patients" before they head to the OR, Dr. Levinson says.

When Cancer Is Suspected but not Confirmed

In cases where a patient's scan shows an ovarian mass that looks suspicious but hasn't been confirmed as cancer, surgeons may perform either laparoscopic surgery or a laparotomy to remove the mass and study the tissue with a pathologist. Together, they'll determine whether cancer is present, and how to proceed. At Johns Hopkins, for example, if doctors are concerned that there’s a high possibility that a malignancy is present, they’ll make a patient’s case a high priority.

Ovarian cancer surgery can take anywhere between three and seven hours, and post-operative recovery typically is three to seven days. Following surgery your healthcare team will encourage you to be up and moving as soon as possible because the more you're moving around the faster you'll heal.

The Importance of Choosing a Specialist for Your Surgery

One of the most important decisions you can make before proceeding is to choose who will perform your surgery. Gynecologic oncologists, who have specialized training beyond general surgery and obstetrics and gynecologytypically, at least four additional years of surgical experienceare specialists in exactly this type of operation. Many studies have shown that ovarian cancer surgery performed by a gynecologic oncologist (rather than a general gynecologist or a general surgeon) leads to better survival outcomes for women, one gynecologic oncologist told SurvivorNet. "We are the specialists who are trained in ovarian cancer surgery."

Your general gynecologist, primary care physician, or oncologist may be able to refer you to a gynecologic oncologist in your area. Or you can do some homework and compile a list of potential surgeons, finding out who's covered by your insurance, and who has operating privileges at highly regarded hospitals or cancer centers near you. You can also ask people you know who have had similar procedures and were happy with their choice.

Learn more about SurvivorNet's rigorous medical review process.

---