Now or Later? Defining the Ideal Time for Surgical Cytoreduction in Advanced Ovarian Cancer

Ovarian cancer is the most lethal gynecologic malignancy in the United States, with more than 20,000 new cases and 12,730 deaths estimated in 2025. Surgical cytoreduction and platinum-based chemotherapy are critical in the management of advanced ovarian cancer. Decisions regarding timing of surgery are complex and must factor in the both the distribution of disease (dictating the likelihood of complete resection and radicality required to achieve this) and the fitness of the patient. Here, we review the landmark studies evaluating surgical timing in patients with advanced ovarian cancer (primary cytoreductive surgery versus interval cytoreductive surgery after neoadjuvant chemotherapy) and highlight the current limitations of the data. While questions remain, complete cytoreduction at the time of surgery confers optimal oncologic outcomes and should be prioritized regardless of the timing of surgery.