Surgical Management of Total Abdominal Hysterectomy plus Bilateral Salpingo-Oophorectomy

Preoperative Considerations

The National Comprehensive Cancer Network recommends appropriate bowel preparation, especially if bowel resection might be necessary 1
Patient should be positioned for a vertical midline abdominal approach for optimal exposure, as suggested by the National Comprehensive Cancer Network 3

A paramedian incision should be made to access the abdominal cavity, as recommended by the British Journal of Cancer 1, 2
The entire abdominal cavity should be thoroughly explored to assess disease extent, according to the British Journal of Cancer 1, 2
Complete excision of the lumbar-ovarian vessels bilaterally should be performed, as suggested by the British Journal of Cancer 1
Total hysterectomy with vaginal closure should be performed, as recommended by the British Journal of Cancer 1
Infracolic omentectomy should be completed, as suggested by the National Comprehensive Cancer Network and the British Journal of Cancer 1, 2, 3
Appendectomy should be performed, as recommended by the British Journal of Cancer 1, 2
Pelvic and para-aortic nodes should be assessed, and suspicious or enlarged nodes should be removed, according to the National Comprehensive Cancer Network and the British Journal of Cancer 1, 3
Routine peritoneal biopsies should be taken from multiple sites, as suggested by the British Journal of Cancer 1, 2

The National Comprehensive Cancer Network recommends removing all visible disease when possible for optimal cytoreduction 1, 3
For early-stage ovarian cancer in women desiring fertility preservation, unilateral salpingo-oophorectomy with preservation of the contralateral ovary and uterus may be considered, as suggested by the Annals of Oncology and the National Comprehensive Cancer Network 6, 7
In advanced disease, the volume of residual tumor after surgery significantly impacts prognosis, with patients having complete or optimal excision having better survival, according to the British Journal of Cancer 1, 2

The operative report must include a precise and detailed description of operative findings and surgery performed, as recommended by the British Journal of Cancer 1, 2
Documentation should specify the side, presence/absence of exophytic growths, ruptured capsule, histological type, and degree of differentiation, as suggested by the British Journal of Cancer 4
The quality of excision margins should be documented, especially in cases of extensive surgery, according to the British Journal of Cancer 4