Surgery may be used to stage the cancer, and as a form of therapy. The type of surgery offered will depend on several factors such as the stage of the disease, the patient’s age, performance status and desire or not to retain fertility.

Women with early-stage disease should have staging surgery that includes a hysterectomy and bilateral salpingo-oophorectomy (NCI 2019). In women who want to bear children but have apparent stage I tumours, unilateral salpingo-oophorectomy with comprehensive surgical staging may be a reasonable treatment option because this is associated with a low risk of cancer recurrence (NCI 2019).

Women diagnosed with more advanced stage (II and III) disease may benefit from a total abdominal hysterectomy and bilateral salpingo-oophorectomy and more extensive cytoreductive surgery before chemotherapy (NCI 2019).

Some patients with advanced disease (III and IV) who are deemed unlikely to achieve optimal debulking or who have medical contraindications to surgery may benefit from chemotherapy before surgery.

Timeframe for starting treatment

Surgery should be conducted within four weeks of the suspected or confirmed diagnosis and within two weeks of the MDM.

Training and experience required of the surgeon

Gynaecological oncologist (CGO) with adequate training and experience in gynaecological cancer surgery as well as institutional cross-credentialing and agreed scope of practice within this area.

Documented evidence of the surgeon’s training and experience, including their specific (sub-specialty) experience with ovarian cancer and procedures to be undertaken, should be available.

Health service characteristics

To provide safe and quality care for patients having surgery, health services should have these features:

• critical care support
• in-house access to radiology
• 24-hour medical staff availability
• 24-hour operating room access and intensive care unit
• diagnostic imaging
• pathology
• nuclear medicine imaging.

There is strong evidence to suggest that high-volume hospitals have better clinical outcomes for complex cancer surgery such as ovarian resections (Wright et al. 2017, 2019). Centres that do not have sufficient caseloads should establish processes to routinely refer surgical cases to a high-volume centre.