Effective chemotherapy allows the performance of surgical cytoreduction to have improved outcomes. This chapter provides an outline for the rationale and implementation of a comprehensive cytoreductive surgical approach in advanced ovarian cancer. The most important prognostic factors refer primary surgical outcome and the response to postoperative chemotherapy. Multiple retrospective studies, pooled exploratory analyses and meta-analyses have demonstrated that the amount of residual disease after cytoreductive surgery inversely correlates with progression-free survival (PFS) and overall survival (OS). Disease involving the upper abdomen cephalad to the greater omentum (UAD) is frequently seen in women with ovarian cancer. Complications involving debulking of the left upper quadrant during cytoreduction have been evaluated. In centres where a comprehensive primary surgical approach can be offered, a primary cytoreductive approach should be the standard of care except for the high-risk group of women.