Primary surgery in ovarian cancer: current opinions

There have been no controlled clinical trials supporting the use of primary cytoreductive surgery. The question remains as to whether the observed survival benefits for patients subjected to primary cytoreductive surgery are an effect of surgical skill or tumour biology. The proponents of tumour biology claim that cytoreductive surgery is a selective procedure, choosing patients with better prognosis. This paper discusses indirect evidence in the literature in support of, or in contradiction to, this hypothesis.