Interval debulking surgery for advanced ovarian cancer: when, how and why?

: Ovarian cancer is the most fatal gynecological malignancy in developed areas. More than two-thirds of women with ovarian cancer have advanced disease at diagnosis. The standard treatment for advanced stage has been primary debulking surgery (PDS), aimed to achieve the complete resection of macroscopic disease, followed by platinum-based chemotherapy. The absence of residual tumor after surgical cytoreduction represents the most significant prognostic factor. The feasibility of complete cytoreduction depends on the resectability of the tumor and the operability of patients, respectively related to the extension of disease and patients’ comorbidities. For cases where PDS is not feasible for these reasons, an alternative strategy was developed in the last decades, the so called interval debulking surgery (IDS). This pathway consists of three or four courses of neoadjuvant platinum-based chemotherapy followed by IDS and a completion of other three courses of platinum-based chemotherapy. Actually, it represents an effective option to improve the rate of women who could benefit of a cytoreductive surgery. In this review we critically explore the current literature and report the evidence about the role of IDS in the management of advanced ovarian cancer, focusing on pros and cons of both strategies (PDS and IDS) and patients’ selection process.