Should an Attempt at Aggressive Cytoreduction be Made for all Surgical Candidates with Advanced Ovarian Cancer prior to Treatment with Adjuvant Chemotherapy?

The concept that aggressive cytoreduction attempts be made for all surgical candidates does not seem to be a realistic goal as evidenced by recent publications. There is no doubt that primary surgery has an important role, but equally so does neo-adjuvant chemotherapy. The latter approach is evidence based, showing similar survival patterns but less morbidities and postsurgical in-patient stay. However, randomized trials where the evidence is contrary to accepted practise often generate heated criticisms, others fitting beliefs are applauded. It is welcome that there is an ongoing trial addressing primary surgery, and hopefully this will contribute in identifying those where aggressive primary surgery is best employed. The survival for advanced ovarian cancer remains poor, and rather than considering a single approach as optimum, strategies to individualize treatments and examine novel therapeutic approaches seems a more logical way to improve survival rates.