Primary cytoreduction for advanced epithelial ovarian cancer

It is undeniable that most patients with advanced ovarian cancer derive benefit from primary cytoreductive surgery, with relief of symptoms, prolonged survival, improved quality of life, and establishment of a definitive diagnosis. Several questions, however, remain unanswered, including the relative effects of surgical intervention and tumor biology and the benefit of ultraradical debulking with or without technologic advances, such as the CUSA or laser therapy. Future studies will likely clarify many issues, including the therapeutic index of neoadjuvant chemotherapy and interval debulking compared with standard treatment and the impact of debulking within homogeneous cohorts of patients (i.e., stage IIIc) with similar host factors.