Surgical debulking of ovarian cancer: what difference does it make?

Three-quarters of women who are newly diagnosed with invasive epithelial ovarian cancer present with stage III to IV disease. Recent data on the efficacy of neoadjuvant chemotherapy have served to challenge the conventional dogma that the preferred initial treatment is surgical debulking. Most of these patients will achieve remission regardless of initial treatment, but 80% to 90% of patients will ultimately relapse. The timing and clinical benefit of a second debulking operation is even more contentious. This article focuses on the recent debate of when or if patients with ovarian cancer should undergo aggressive surgical resection of bulky disease.