Advanced Ovarian Cancer Surgery for Stage 3 and Stage 4
Indian Ovary Cancer Institute (IOCI), Ahmedabad. What the operation removes, how you get ready, the days in hospital and what comes after, explained by Dr Swati Shah.
Surgery for advanced ovarian cancer removes every visible deposit from the belly and pelvis. It can include the womb, ovaries, fatty apron, bowel and diaphragm lining. Chemo always follows it.
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Dr Swati Shah
MS, DrNB (Surgical Oncology)
Ovary Cancer Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Indian Ovary Cancer Institute (IOCI), Shah’s Gastro, Cancer & Robotic Surgery Centre. Trained at busy cancer centres. Fully qualified in cancer surgery. 18 years of experience in cancer surgery for women. Rated 4.96 from 24 Google reviews at the IOCI clinic, and 4.95 from 66 at Apollo Hospital, Bhat.
Last updated: 19 October 2026
What advanced ovarian cancer means
Advanced means stage 3 or stage 4. In stage 3 the cancer has spread over the lining of the belly. In stage 4 it has reached the chest or organs like the liver.
Ovarian cancer rarely stays in the ovary for long. It sheds cells into the belly. These cells settle on the fatty apron (the omentum), on the lining of the belly, on the bowel and under the diaphragm. Fluid often builds up. That fluid is called ascites. The belly swells, food fills you quickly, and clothes feel tight.
The same disease can start in the fallopian tube or in the lining of the belly itself. Doctors treat all three as one cancer. The stage on a scan is only a first guess. The true stage is set at surgery, when the surgeon sees and feels every surface.
Most women in India are found at this stage. That is not a reason to give up. This cancer usually responds well to chemo. Good surgery plus good chemo gives many women years of good life. The key is to plan both well from the first visit.
The goal: leave no visible cancer
The single aim of the operation is to leave no cancer that the eye can see. Doctors write this as R0 or CC-0. It matters more than how big the operation is.
Years ago surgeons were happy to leave small lumps behind. That is no longer the standard. Leaving nothing visible gives clearly better results than leaving even small nodules. So we do not plan a “part” operation. If we cannot remove everything at the start, we give chemo first and operate later. We explain this choice in detail on our page about surgery first or chemo first.
This is why the operation for advanced disease is different from a cyst removal. It is a planned, careful search of the whole belly. Every deposit found is taken out. The operation can take many hours. It needs an experienced team, a good ICU and a blood bank on standby. Apollo Hospital, Bhat, has all three.
What the operation can remove
The operation removes what is needed and nothing more. The table shows each area, what is done there and why. Your own plan depends on where the deposits are.
| Area | What is done | Why |
|---|---|---|
| Womb, tubes and ovaries | Total hysterectomy with both tubes and ovaries | This is where the cancer starts |
| Fatty apron (omentum) | Omentectomy, below and often above the colon | It is the commonest place for deposits |
| Lining of the belly and pelvis | Peritonectomy, the diseased lining is stripped | Deposits sit on this lining |
| Bowel | Bowel resection where a part is involved | To remove every visible deposit |
| Under the diaphragm | Diaphragm stripping, sometimes a small cut-out | Disease here is often missed |
| Spleen, gallbladder, tail of pancreas | Removed only when deposits sit on them | To reach zero visible disease |
| Lymph glands | Only enlarged glands are removed | Removing normal glands adds risk without benefit |
Not every woman needs every step. Many need only the first three. Some need bowel or upper belly surgery as well. The CT scan gives a first map. A keyhole look (diagnostic laparoscopy) can confirm it when the scan is not clear.
On lymph glands, the evidence is clear. In advanced disease, when the glands look normal and all visible cancer is gone, removing all of them does not help survival. It only adds risk. So we remove only the glands that are enlarged.
Will I need a bag (stoma)
Most women do not need a stoma. Some do, when a part of the bowel is removed low in the pelvis. It is often temporary and can be closed later.
When a part of bowel is removed, the two ends are usually joined again. Sometimes, low in the pelvis, we protect that join with a temporary stoma. A stoma is an opening of the bowel on the belly. Stool goes into a small bag. Most temporary stomas are closed after a few months, once chemo is over and the join has healed.
We never decide this on the day. If the scan shows the bowel may be involved, we talk about a stoma before surgery. The stoma nurse marks the right spot on your belly while you sit and stand. You sign consent for it in advance. You will not wake up to a surprise.
Is HIPEC added to the operation
HIPEC is heated chemo washed through the belly during surgery. Trials support it when surgery follows chemo in stage 3. It is not added when cancer is left behind.
HIPEC stands for hyperthermic intraperitoneal chemotherapy. After all visible cancer is removed, warm cisplatin is circulated through the belly for about 90 minutes. A trial called OVHIPEC-1 showed a survival gain in one setting. That setting is stage 3 disease, operated after three cycles of chemo, when every visible deposit is gone.
At a first operation done before any chemo, HIPEC is still under study. We say so plainly. If the cancer cannot all be removed, HIPEC is not added at all. Apollo Hospital, Bhat, has the heated-perfusion machine in house, so the choice rests on your disease, not on what is available. Read more on our page about HIPEC for ovarian cancer.
Getting ready for surgery
The weeks before surgery matter. Walking, breathing exercises, protein and a good blood count lower the risk of problems and help you go home sooner.
- Tumour board review. Your scans and reports are discussed by surgeons, oncologists, radiologists and pathologists together.
- Tissue and gene test. A needle biopsy confirms the cancer. The BRCA and HRD gene test is sent at the start, because its result decides the tablet you take after chemo.
- Bowel check if needed. If blood markers do not point to the ovary, a colonoscopy and endoscopy come first.
- Build strength. Walk every day. Use the breathing device. Take the protein drink. Iron is corrected if your haemoglobin is low.
- Stoma marking and consent. Where bowel may be removed, the stoma nurse marks the spot and you sign consent in advance.
If you have lost a lot of weight, or your albumin is low, we may give chemo first and build you up. A strong body handles a long operation much better. This is one of the main reasons chemo is sometimes given before surgery.
The days in hospital
Most women go home within about a week. Recovery follows a set plan from the day of surgery. You sit up, sip, and start walking early.
| Day | What happens |
|---|---|
| Day of surgery | Some women stay in ICU for a night. You sit out of bed after a few hours and take small sips of water. |
| Day 1 | Liquid diet. Walk three times with help. The urine tube usually comes out. |
| Days 2 to 3 | Soft diet. Drips are stopped. Pain is controlled with tablets. |
| Days 4 to 7 | Drains come out. Stoma training if needed. Discharge once you eat, walk and pass motion. |
Before you go home, your family learns how to give a daily blood-thinning injection. You take it for four weeks. Ovarian cancer surgery carries a higher risk of clots in the legs and lungs than other cancer surgeries for women, and this injection lowers it. We also book your first chemo visit before discharge, so nothing is delayed.
Risks we discuss before you sign
This is major surgery and it carries real risks. We go through each one with you and your family before consent, in your own language.
- Bleeding. A blood transfusion may be needed.
- Infection of the wound or inside the belly.
- Clots in the legs or lungs. The four weeks of injections lower this risk.
- Leak from a bowel join. It shows as fever and a fast pulse a few days later, and is treated at once.
- Fluid near the lung after diaphragm surgery. It sometimes needs a small drain.
- Slow bowel for a few days, with bloating or vomiting.
- Injury to the bladder or ureter, repaired during the same operation.
- A small risk to life, higher with very large operations and HIPEC.
Some changes are certain, not risks. If both ovaries are removed, menopause starts at once. Pregnancy is no longer possible. Chemo follows surgery in every case. And you will need follow-up for life. Hot flushes and bone health can be treated, and we talk about this too.
After surgery: chemo and the tablet that follows
Chemo starts three to four weeks after surgery. After chemo, many women take a daily tablet chosen by their gene test. This keeps the cancer quiet for longer.
The usual chemo is carboplatin and paclitaxel, given every three weeks. You need six cycles in all. If you had chemo before surgery, you finish the rest after it. Some women also receive bevacizumab, a drug that cuts the blood supply of the cancer.
After chemo comes maintenance. The choice depends on the BRCA and HRD result. Women with a BRCA change usually take olaparib for two years. Others may take niraparib, or olaparib with bevacizumab. That is why the gene test is sent at the very first visit. Waiting for it at the end is the most common avoidable delay.
If you have a BRCA change, your sisters, daughters and other close relatives can be tested too. We arrange that counselling. A positive result in a relative lets her take steps early.
When surgery is not the first step
Surgery is not done first when the cancer cannot all be removed yet, or when you are too weak for a long operation. Chemo comes first in both cases.
Some findings make complete removal unlikely at the start. Examples are disease deep at the root of the small-bowel mesentery or around the liver’s entrance. In these cases three or four cycles of chemo shrink the cancer. Then surgery is done. This is called interval debulking. Large trials show it gives similar survival with fewer complications in these women.
Age alone does not rule out surgery. Fitness does. We judge your heart, lungs, nutrition and daily activity. An older woman who is active is often a good candidate. A younger woman who is very weak may need chemo first to get stronger.
Your journey with us, step by step
- Step 1: Book your consultation. Send your reports first. We read them before you arrive at the Gota OPD.
- Step 2: Tests and treatment plan. CT, markers, biopsy and gene test. The tumour board sets your plan.
- Step 3: The surgery. At Apollo Hospital, Bhat, with the full team and ICU on hand.
- Step 4: A short hospital stay. About a week for most women, on a set recovery plan.
- Step 5: Follow-up and full healing. Chemo, the maintenance tablet, then visits every three months for two years.
What cytoreductive surgery means in advanced ovarian cancer. A short film from IOCI.
What patients say
★★★★★
“My relative was diagnosed with Stage 3 ovarian cancer involving the omentum and peritoneal deposits. We consulted Indian Ovarian Cancer Institute (IOCI), where the complete treatment plan was explained in detail. The team successfully performed Cytoreductive Surgery (CRS) with the goal of complete tumour removal. We were impressed by the surgical expertise, teamwork, and post-operative care. We would confidently recommend IOCI to anyone seeking treatment for advanced ovarian cancer. Special thanks to Dr. Swati Shah who was very patient and answered all our questions patiently. — Adv. Sanjay D, Google review, IOCI clinic listing”
★★★★★
“My relative had advanced ovarian cancer involving the omentum and peritoneal deposits. We consulted Indian Ovarian Cancer Institute (IOCI) because of its expertise in complex ovarian cancer surgery. The doctors explained the importance of achieving complete tumour removal, and Cytoreductive Surgery (CRS) was performed successfully. We are thankful for the excellent treatment and compassionate care provided throughout the journey. — Sharukh Bhadula, Google review, IOCI clinic listing”
★★★★★
“I am very thankful to Dr. Swati Shah for treating and operating on my mother for ovarian cancer. From the first consultation to the surgery and follow-up, she was very supportive, caring, and explained everything clearly. We felt confident and comfortable under her care. The surgery went well, and my mother is recovering nicely. We are truly grateful for her expertise and dedication. Highly recommended for ovarian cancer treatment and surgery in Ahmedabad. — Sonal Soni, Google review, Apollo Hospital, Bhat listing”
Cost, insurance and admission
The cost depends on the extent of surgery, HIPEC, ICU days and hospital days. The Apollo Hospital, Bhat, insurance desk arranges cashless approval where your policy allows.
We give you a written estimate once the plan is set. The main things that move it are bowel or upper belly surgery, HIPEC, and the number of days in ICU. Bring your insurance card, policy papers and photo ID to the first visit. Then pre-authorisation can start early. Plan also for chemo and the maintenance tablet. The tablet can be the largest single cost, so we discuss it at the start, not at the end.
Frequently asked questions
Can stage 3 ovarian cancer be operated?
Yes. Most stage 3 cancers are operated, either first or after three or four cycles of chemo. The aim is to remove every visible deposit. Chemo always follows.
Is surgery useful in stage 4 ovarian cancer?
Often, yes. When the spread outside the belly is limited, chemo is given first and then surgery removes the disease in the belly. The decision is made case by case at the tumour board.
How long does advanced ovarian cancer surgery take?
Usually several hours. A longer operation is not a bad sign. It means the surgeon is searching every surface and removing every deposit found.
How many days will I stay in hospital?
Most women go home in about a week. Some spend a night in ICU first. Bowel or diaphragm surgery can add a few days.
Will I need a stoma bag after the operation?
Most women do not. A temporary stoma is sometimes made to protect a low bowel join. We discuss it before surgery, and most are closed later.
Can the surgery be done by keyhole or robot?
Advanced disease is usually operated open, because every surface must be seen and felt. A keyhole look is often used first, to judge whether everything can be removed.
Where Dr Swati Shah sees and operates
IOCI clinic, Gota, Ahmedabad
Indian Ovary Cancer Institute I Ovary cyst & tumour treatmentSF-203, 2nd Floor, Olive Greens, Gota, S G Highway, Ahmedabad, Gujarat 382481
Apollo Hospital, Bhat
Dr Swati Shah Gynec Oncologist I Uterus, Cervix, Ovary Cancer I Robotic & CRS HIPECApollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar, Gujarat 382428
Visits at the IOCI clinic, Gota, Ahmedabad. Surgery at Apollo Hospital, Bhat, Gandhinagar.
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