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Hysterectomy with bilateral salpingo-oophorectomy for early stage ovarian cancer

General

When ovarian cancer is confirmed, radical surgery is usually performed by removal of both ovaries (bilateral salpingo-oophorectomy – BSO) and the uterus (hysterectomy), as well as extirpation of pelvic and paraaortal lymph nodes. It is very important to thoroughly inspect the peritoneum in the upper abdomen including the diaphragm.  Random biopsies are taken of the peritoneum lateral to the ascending and descending colon. This type of surgery can also be performed by conventional laparascopy or robot-assisted surgery.

For ovarian cancer in younger women wishing to preserve their fertility, it may be possible to leave the healthy ovary and uterus. This is possible if the tumor is localized to one ovary and the patient is at low risk for recurrence. 

The risk assessment is based on the histological type, grade of differentiation, and ploidy. The result of these examinations will not be available until some time after the operation. If the examinations indicate a high risk for recurrence, it may be necessary to remove the remaining ovary in a subsequent laparoscopic procedure. 

Borderline ovarian cancer usually occurs in younger women still wishing to become pregnant. Since these tumors are rarely bilateral, it may be adequate to perform a unilateral adnexal extirpation. It is recommended to do an omentectomy for a full stage evaluation. If the contralateral ovary is normal in appearance, it is recommended to avoid taking a biopsy from this ovary. There are no reasons for lymph node staging.

With spreading of borderline tumors, it is recommended to resect as much as possible. For aneuploid tumors, there is a significant risk for recurrence. This is the cause for immediate surgery with a bilateral salpingo-oophorectomy and omentectomy. A hysterectomy is not necessary unless there are implantations on the uterus.

The appendix is removed in the case of mucinous tumors.

Because of the danger of spreading of ovarian cancer to the peritoneum, the omentum is also often removed (omentectomy).

The ovary can also be removed if there is suspicion of cancer to establish a histological diagnosis. During the operation, the ovary is examined using frozen sections to obtain a histological diagnosis. The diagnosis is normally available after 30 minutes. Based on the histological diagnosis, further course of action for the operation is planned.  

Indication

  • Suspect or confirmed ovarian cancer

Goal

  • Curative treatment and stage determination

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