ABSTRACT
Surgery and chemotherapy are the major contributors to the management of patients with advanced epithelial ovarian cancer. The role of surgery has been basically twofold, i.e., for diagnosis and treatment (cytoreduction) (1). Some clinicians feel that surgery, as a diagnostic test for advanced ovarian cancer, has been rendered rather obsolete by the current state of medical imaging and invasive radiology (2). However, most still accept the present standard to perform cytoreductive surgery up front when it may result to zero or minimal residual disease (3). Alternative approaches have been applied for patients with very advanced ovarian cancer with massive peritoneal carcinomatosis and/or stage IV disease in whom optimal debulking seem to be far from realistic (4,5). Unfortunately, to date, no randomized study on initial cytoreductive surgery prior to chemotherapy has been reported and so the value of this standard approach to the management of patients with advanced ovarian cancer is mainly based on retrospective evidence.
