Summary

Surgery is the cornerstone of advanced ovarian cancer treatment. Complete surgery without tumor residue is the main independent prognostic factor of advanced ovarian cancer management. This absolute requirement guides surgical strategy. Ovarian cancer spreads into abdominal cavity leading to multivisceral metastases. To treat this peritoneal carcinomatosis, complete surgery is a tool among other treatments, such as chemotherapy, PARP inhibitors, antiangiogenics. Taking this multimodal treatment into account we observed during the past years some surgical de-escalation and some surgical escalation validated by randomized trials. In the first part of this review are discussed initial assessment, the need for surgical standardization in order to obtain complete cytoreduction, primary surgery and interval surgery, ultra radical surgery, surgery for the first relapse, intraperitoneal chemotherapy and hyperthermic intra peritoneal chemotherapy. In the second part the main ongoing randomized trial based on surgical issue are presented. Results of these trials will change surgical strategy.