Objective To evaluate the present status of cytoreductive operations in the treatment of advanced ovarian carcinoma. Design Review of the relevant literature. Result At present it is still accepted that the maximum diameter of the largest tumour mass remaining should optimally not exceed 1.0-1.5 cm because of its influence on survival. Other biological factors may be of equal or greater importance to the outcome as is the extent of surgery. A clear restriction of the procedure is that extensive debulking procedures, such as peritoneal stripping technique, or bowel resections, have so far demonstrated no improvement in survival. In particular, patients with mainly extensive stage III or TV disease, have fared no better after optimal cytoreductive surgery than patients who still had residual disease at the completion of surgery. This observation underlines that the initial tumour burden as well as the tumour residue influences prognosis. It also seems that the particular group of patients with largely irresectable large disease in the abdomen, does not benefit at all from cytoreductive surgery. For this reason intervention cytoreductive surgery after at least three courses of chemotherapy and a proven partial response, seems to be a logical option. Conclusions At present it is clear that the residual tumour mass and the initial tumour mass are important factors for prognosis. It seems logical that, especially in patients with large initial tumour masses, neoadjuvant chemotherapy is an option that should seriously be considered. A randomized trial is needed to study the real value of this approach.
