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Surgery in ovarian cancer: the concept of cytoreductive surgery.

Critical analysis of the collected evidence on cytoreductive surgery suggests a median survival benefit of 9-12 months in combination with platinum-based chemotherapy. Recently, a randomized study on the value of secondary cytoreduction showed a median survival benefit of 6 months for those with small residual disease after the second operation. Primary cytoreduction is feasible in approximately 70% of patients, with an acceptable level of morbidity. The reported evidence justifies a serious attempt at cytoreductive surgery at the first operation by an experienced gynaecological oncologist.