[The role of surgery for advanced epithelial ovarian cancer]

Advanced epithelial ovarian cancer means. A unique approach to the treatment because almost always the chemotherapy challenge begins in the disseminated condition in the whole abdomen. This aggressive challenge is dependent on a 60-70 % response rate of cisplatin containing regimen for this tumor. The chemotherapy combined with maximum cytoreductive effort can expect long term survival, since the less the residual tumor diameter, the longer the expected. Unless surgery is successful at the beginning, secondary optimal surgery after the effective chemotherapy contributes to the survival. Suboptimal secondary cytoreduction, however, has no benefit for the subsequent course. Several studies documented primary bulky tumor affected the prognosis even after successful debulking surgery and chemotherapy. No prospective study clarified the advantage of neoadjuvant chemotherapy for long term survival in advanced ovarian cancer. Comprehensive combination study for initial debulking surgery, chemotherapy and secondary cytoreduction will help verify the optimal schedule. Systematic pelvic and paraaortic lymph node dissection is controversial to date. A metastatic lymph node is one of prognostic factors, but the removal of it may be not necessarily associated with improvement of survival. We must clarify the clinical advantage for systemic lymph node dissection in well-designed prospective random study. We have to perform the second look operation when this procedure contributes the subsequent outcome.