Ovarian Cancer Surgery: What Happens, Step by Step
Last updated: 13-Oct-2026
Dr Swati Shah
MS, DrNB (Surgical Oncology)
Ovary Cancer Surgeon
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ 4.96 from 24 Google reviews
IN SHORT
The operation has one aim: to remove every bit of cancer that can be seen. Removing most of it is not the goal, because what is left behind matters.
Keyhole surgery often comes first, to look inside, score the spread and take a tissue sample. The bigger operation is planned from what it shows.
If the surgeon finds that not all the cancer can come out, the operation stops after a sample. Chemotherapy comes first, and the main operation follows later.
This page is one part of a larger guide. For who needs this operation, how it is planned and what the stages mean, see advanced ovarian cancer surgery (stage 3 and 4) in Ahmedabad.
The aim: no cancer left that the eye can see
Ovarian, tube and peritoneal cancer are treated as one disease. They are operated on in the same way. The surgeon cannot change the type of tumour. The surgeon can change how much cancer is left at the end. That is the strongest factor in the surgeon’s hands.
So the target is always zero visible disease. Leaving small pieces behind is not counted as a good result here. Every case also goes to the tumour board first. The board decides whether the operation or chemotherapy comes first.
| Timing | When it is chosen |
|---|---|
| Operation first. | All visible cancer can be removed, and the woman is fit for a long operation. |
| Chemotherapy first, operation after three or four cycles. | The spread is too wide to remove now, or strength and nutrition need time. |
Getting the body ready
Preparation starts at the first visit, not the night before. It helps the body handle a long operation. These are the usual parts:
- Walking every day, breathing exercises with a small device, and protein drinks.
- Low iron and low haemoglobin are corrected before the operation.
- A stoma nurse marks a site on the abdomen if bowel surgery is possible.
- A sugary drink the evening before, and another two to three hours before. It is skipped if the bowel is blocked.
- No solid food for six hours before. Clear fluids are allowed until two hours before.
- No bowel wash-out, unless part of the bowel is planned for removal.
- A blood-clot check is written down, and antibiotics are given as you go to sleep.
Keyhole first: looking before removing
A diagnostic laparoscopy passes a small camera into the abdomen. The surgeon sees the lining, the bowel and the upper abdomen, and scores the spread.
A CT scan shows a lot, but it misses thin deposits. So the scan alone never decides whether all the cancer can come out. That is checked by laparoscopy with a scoring system, or by an open look. A tissue sample is also taken if one is still needed. Chemotherapy never starts on a fluid test alone.
On this pathway, keyhole surgery has a set job: to look, to score and to take a sample. The removal operation is then planned around where the disease has spread. How it will be done in your case is explained at the visit.
The main operation, in order
Not every woman needs every part. The spread of the disease decides. The table follows the usual order.
| Part | What the surgeon does | Why |
|---|---|---|
| Washings. | Fluid is washed from the abdomen before anything is touched. | Loose cancer cells can change the stage. |
| Womb, tubes and ovaries. | The womb, both tubes and both ovaries are removed. | They hold or border the main tumour. |
| Omentum. | The fatty apron below the bowel is removed. Sometimes the part near the stomach goes too. | It often hides deposits. |
| Lining samples. | In early-looking disease, samples come from set places on the lining. | Hidden spread is looked for. |
| Appendix. | Removed when the tumour is the mucinous type. | It is part of the operation for this type. |
| Upper abdomen. | Deposits are cleared from the diaphragm. The spleen, the tail of the pancreas or the gallbladder may be removed. | Only when needed to leave no visible cancer. |
| Bowel. | A piece of bowel is removed if that clears the last cancer. | A stoma may be needed. |
Lymph nodes: when they are removed, and when not
In early-looking disease, nodes in the pelvis and along the aorta are removed to find hidden spread. In advanced disease, normal-looking nodes are left alone.
Why the difference? In advanced disease, once all visible cancer is out, clearing normal nodes adds harm. It does not help survival. Only large, swollen nodes are removed then. In early-looking disease the nodes are part of staging, because a positive node changes the stage and the plan.
When the operation stops
Sometimes the problem only shows once the abdomen is open. The cancer may be on the root of the small-bowel mesentery, or around the liver’s main entry. If all visible cancer cannot be removed, a partial removal is not done. It does not help. The surgeon takes a biopsy and closes. Chemotherapy is given first, and the main operation follows after three or four cycles.
At that later operation, for stage III disease, heated chemotherapy may be washed through the abdomen. This is called HIPEC. It runs for about ninety minutes, and only after all visible cancer is removed. HIPEC at a first operation is still being studied, and is explained as such. The HIPEC machine at Apollo Hospital, Bhat is booked when the operation is listed. Our HIPEC page explains it further.
Inside theatre: small things that help recovery
- Pain relief that keeps strong opioid medicines low.
- Fluids given by measurement, not by habit.
- Body warmth kept up, except during the heated chemotherapy.
- No stomach tube left through the nose as routine.
- Drains only after bowel or diaphragm surgery, or HIPEC.
- Blood-thinning injections for four weeks after going home. The family is taught to give them.
Days in hospital, and what is watched, are covered in our recovery after ovarian cancer surgery page.
To return to the full guide, go back to advanced ovarian cancer surgery.
Some things are certain, not risks. If both ovaries are removed, menopause starts at once. Pregnancy is no longer possible, unless a fertility-sparing operation was planned beforehand. Chemotherapy follows the operation. Consent for bowel removal and a stoma is always taken before surgery. Questions worth asking before you sign:
- Ask whether bowel removal or a stoma is likely in your case.
- Ask whether HIPEC is part of the plan.
- Ask which upper-abdomen organs may need to come out.
- Ask when chemotherapy will start after the operation.
Frequently asked questions
Will my operation be done through keyhole?
Keyhole surgery is used to look inside, score the spread and take a sample. How the main removal is done depends on where the disease is. Dr Swati Shah explains this at your visit.
Why remove the omentum if it looks normal?
The omentum is a fatty apron inside the abdomen. Small deposits hide in it that no scan shows. Removing it is a standard part of the operation.
Will I wake up with a stoma?
Only if part of the bowel has to be removed to clear the cancer. Consent is taken before surgery, and a stoma nurse marks a suitable site in advance.
Why is my appendix being removed?
If the tumour is the mucinous type, the appendix is removed during the same operation. It is a standard part of the operation for this type.
What if the surgeon cannot remove everything?
A partial removal is not done. A biopsy is taken and the abdomen is closed. Chemotherapy comes first, and the main operation follows after three or four cycles.
Related pages
For the full picture of ovarian cancer care at the institute, read our ovarian cancer page, which brings stages, surgery and chemotherapy together.
Shah’s Gastro, Cancer & Robotic Surgery Centre
Dr Swati Shah — MS, DrNB (Surgical Oncology) · Ovary Cancer Surgeon
Consultation: Gota OPD, Gota, Ahmedabad. Surgery: Apollo Hospital, Bhat, Gandhinagar.
Indian Ovary Cancer Institute I Ovary cyst & tumour treatment — SF-203, 2nd Floor, Olive Greens, Gota, S G Highway, Ahmedabad, Gujarat 382481
Dr Swati Shah Gynec Oncologist I Uterus, Cervix, Ovary Cancer I Robotic & CRS HIPEC — Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar, Gujarat 382428
Call: +91-63590-11009 · WhatsApp: +91-63590-11009
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