3. Conclusions

With no doubt, the presence of any residual disease after cytoreductive surgery remains the most important adverse prognostic factor that clinicians have to control over. Therefore, complete macroscopic clearance of the peritoneal cavity should always be the aim of surgery. Preoperatively, patients should undergo holistic assessment by gynecologic oncologist with regard of the disease distribution, extent, stage, and resectability; the patients' physical and emotional capacity to cope with the burden of surgery; and their nutritional status. All efforts should be focused on optimizing patients to tolerate the maximal surgical effort with acceptable morbidity and mortality. While primary debulking surgery remains the standard approach for patients with stage 3 ovarian cancer with optimal age, performance status, and nutritional status, there is growing evidence that neoadjuvant chemotherapy offers a safe and effective alternative for patients with less favorable characteristics.
