Table 2

Surgery: ovarian cancer

1b7 or High62 27 or Medium62 3 or Low62
Mechanical intestinal obstruction/impending perforation where lines of life-prolonging treatment exist.7
Pelvic mass with torsion or causing urinary or intestinal obstruction35 		Malignant germ cell tumors in young patients should take priority. Complete staging procedure should be performed with nodal evaluation.49
Image-guided/diagnostic laparoscopy for tissue biopsy/assess operability if high suspicion of cancer35
Elective surgery with the expectation of cure to be performed within 4 weeks to save a life/prevent progression of disease beyond operability
Priority-based on:

  • Urgency of symptoms

  • Complications

  • Expected growth rate


Primary debulking surgery for ovarian cancer, particularly cell types unlikely to respond to neoadjuvant chemotherapy (low grade serous, clear cell, or mucinous)16 35
Presumed early-stage ovarian cancer based on adnexectomy: completion/staging surgery may be deferred for 1–2 months15
Ovarian mass with adverse features but normal tumor markers: ideally operated on within 4 weeks but could be delayed following multidisciplinary tumor board discussion16 		Interval debulking surgery
Secondary surgery in recurrent ovarian cancer: patients should be managed with chemotherapy unless surgery would relieve symptoms7
Pelvic masses following multidisciplinary tumor board discussion, including using MRI/International Ovarian Tumor Analysis ultrasound/Risk of Malignancy Index to decide on the likelihood of malignancy:

  • Thought to be benign: can defer surgery for 3–6 months

  • Risk of Malignancy Index <200: consider virtual clinic appointments and follow-up during the pandemic period7


Risk-reducing surgery for genetic predisposition35