A 54-yrs-old woman undergoes a laparotomy because of a pelvic mass. At exploratory laparotomy, a unilateral ovarian neoplasm is discovered that is accompanied by a large omental metastasis. Frozen section confirms metastatic serous cystadenocarcinoma. Most appropriate intraoperative course of action is
The survival of women who have ovarian carcinoma varies inversely with the amount of residual tumor left after the initial surgery. At the time of laparotomy a maximum effort should be made to determine the sites of tumor spread and to excise all resectable tumor. Although the uterus and ovaries may appear grossly normal, there is a relatively high incidence of occult metastases to these organs, for this reason, they should be removed during the initial surgery. Ovarian cancer metastasizes outside the peritoneum via the pelvic or paraaortic lymphatics, and from there into the thorax and the remainder of the body.
Excision of the omental metastasis and ovarian cystectomy
Omentectomy and ovarian cystectomy
Excision of the omental metastasis and unilateral oophorectomy
Omentectomy, total abdominal hysterectomy, and bilateral salpingo oophorectomy