Operative management of primary epithelial ovarian cancer.

Surgery plays an integral part in the primary management of early-stage and advanced-stage epithelial ovarian cancer. Surgical staging is essential for disease grossly confined to the ovaries or pelvis. Comprehensive surgical staging often results in upstaging of patients who were presumed to be at an early stage. Accurate staging has an impact on prognosis and treatment strategies. Optimal surgical cytoreduction leads to improved outcomes in patients with advanced disease; before initiation of chemotherapy, it offers the most favorable outcome and should be offered to all patients. Intraperitoneal catheters for postoperative chemotherapy instillation may be offered and placed at the time of cytoreduction. Neoadjuvant chemotherapy and interval cytoreduction are a possibility for patients who are not amenable to an optimal cytoreduction based on preoperative findings or in those who are at extremely high risk for surgery.