In advanced-stage ovarian cancer, the evidence base from randomised controlled trials on the role of extensive radical surgery to improve survival is limited. Different interpretations of existing trials have led to variation in surgical practice, not only internationally but also within the UK. A recent randomised controlled trial of 632 women focused on the timing of surgery in advanced-stage ovarian cancer and indicated that there was no detriment to survival in performing primary surgery after three cycles of (neoadjuvant) chemotherapy compared with primary surgery performed before the commencement of any chemotherapy. Perioperative morbidity was shown to be less after neoadjuvant chemotherapy. Other trials have shown conflicting results when further surgery was performed as an interval procedure after suboptimal cytoreduction at primary surgery. Further robust trials are therefore needed to clarify the role of surgery and optimise the timing and extent of surgery in women with advanced-stage ovarian cancer.
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