The Surgery of Ovarian Cancer

Surgery has remained the mainstay of treatment for ovarian cancer despite considerable advances in chemotherapy. The findings and results of the initial laparotomy have a greater bearing on the eventual outcome than do many subsequent therapeutic decisions. Hysterectomy with bilateral salpingo-oophorectomy continues to be the most cogent therapy. Both ovaries are removed because of the frequency of bilateral synchronous tumors and the possibility of occult metastases, which may be between 6 and 43 % even in a normal-looking ovary. The uterus is removed because the uterine serosa and endometrium are also frequent sites for occult metastases, and the prevalence of synchronous carcinoma of the endometrium and ovary is relatively high.