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For some cancers, the only ambition of surgery is to reduce a maximum amount of tumour volume before the use of other potential therapies (such as chemotherapy).

The most significant example is ovarian carcinoma.

Standard operative procedure for an ovarian carcinoma in a woman desiring no further pregnancies.

Surgical approach:

• supra- sub-umbilical median incision to allow a complete inspection

Peritoneal cytology

• either by sampling ascitis liquid
• or by peritoneal washings

Exploration of the peritoneal cavity and description of lesions

• Side and size of ovarian tumour,
• Presence of tumour adherence,
• Spread to the pelvis (uterus, retro-rectal peritoneum),
• Spread to the submesocolic space (small intestine, mesentery, appendix, colon, omentum),
• Spread to supramesocolic space (liver surface, liver parenchyma, biliary ducts, stomach, pancreas, spleen, gastro-hepatic omentum, diaphragmatic peritoneum),
• Spread to parietal peritoneum,
• Study of the retro-peritoneal and lumboaortic nodes.
  

Excision

• Bilateral oophorectomy,
• Radical hysterectomy,
• Omentectomy,
• Appendicectomy,
• Retroperitoneal lymphadenectomy,
• Excision of the maximum number of peritoneal parietal or parenchymatous nodules whilst limiting intestinal resection: chemotherapy should begin less than one month after surgery with rapid postoperative recovery.
  

Surgical operative report

• Precise description of tumours at opening of the cavity,
• Precise description of excisions,
• Precise description of location and size of residual tumours (after surgery).
  

This complete surgical procedure is necessary to classify ovarian carcinoma and define a strategy for the upcoming adjuvant treatment.