[Ovarian cancer and the surgical knife. Advanced ovarian cancer]

Surgery of advanced ovarian carcinoma includes total abdominal hysterectomy, bilateral salpingo-oophorectomy, partial or total omental resection and removal as much secondaries as possible. Distinction between optimal and suboptimal debulking is important in terms of survival. This is based on the size of the diameter of the largest residual tumour following primary surgery (< 2 cm vs > 2 cm). The value of lymphadenectomy is still controversial. However, it should be explored in prospective studies. The role of second-look laparotomy in advanced ovarian carcinoma remains debatable. Secondary debulking appears to be beneficial only if it is followed by adjunctive chemotherapy.