The Invisible Enemy: How Systematic Lesser Omentectomy Matters in Advanced Ovarian Cancer

Objective: This study aims to evaluate the frequency and extent of lesser omentum involvement in advanced ovarian cancer and highlight the importance of systematic lesser omentectomy during cytoreductive surgery (CRS). Materials and Methods: A retrospective analysis of 400 patients with advanced epithelial ovarian cancer (FIGO stages IIIB–IV) was conducted in the Department of Surgical Oncology at All India Institute of Medical Sciences, New Delhi. All surgeries were performed by a single surgeon (M.D.R. or under his supervision), and lesser omentectomy was standardized across cases. Intraoperative findings, including gross and pathological involvement of the lesser omentum, were recorded. Postoperative complications were classified using the Clavien–Dindo system. Results: Gross involvement of the lesser omentum was identified in 48% of cases, whereas pathological involvement was confirmed in 64%. Notably, 32.8% of the pathologically confirmed cases were grossly normal intraoperatively, and hidden metastases were discovered in 12% of cases only after exploring the lesser sac. Lesser omentectomy was performed in an average of 15–20 minutes without significantly increasing surgical time or complications. Clavien–Dindo grade 3 or higher complications were recorded in 12% of patients related to CRS. Conclusions: Lesser omentectomy is beneficial in achieving complete cytoreduction in advanced ovarian cancer, particularly in cases postneoadjuvant chemotherapy where gross disease may not be visible. The procedure enables the removal of occult metastases, improving survival outcomes by enabling complete CRS without significantly increasing postoperative morbidity.