An analysis of patients with bulky advanced stage ovarian, tubal, and peritoneal carcinoma treated with primary debulking surgery (PDS) during an identical time period as the randomized EORTC-NCIC trial of PDS vs neoadjuvant chemotherapy (NACT)

► Primary debulking surgery should continue to be the preferred initial management for patients with advanced-stage ovarian cancer. ► NACT's associated decrease in surgical morbidity is comparable to that of patients who are suboptimally cytoreduced during primary debulking surgery. ► NACT should be reserved for patients who cannot tolerate primary debulking surgery and for whom optimal cytoreduction is not feasible.