Surgery should be the first choice for advanced ovarian cancer. Since 2008, the NCCN guidelines have changed the criteria for satisfactory tumor cytoreduction from a residual lesion of <2 cm to <1 cm, and in the 2011 edition, it is emphasized that although the criterion is set at <1 cm, it is desirable to achieve no visual residual. To achieve this, the satisfactory scope of tumor cytoreduction may include, in addition to the scope of full staging surgery described above, radical pelvic organ resection, diaphragmatic surface or other peritoneal surface tumor debulking, bowel resection, splenectomy, partial hepatectomy, cholecystectomy, partial gastrectomy, partial cystectomy, ureterocystic anastomosis, and pancreatic body and tail resection. In addition, it may include surgery for stage IV ovarian cancer such as supraclavicular lymph node dissection, thoracentesis and drainage, and excision of isolated skin metastatic lesions. After such surgeries, in principle, a clear diagnosis, comprehensive staging, and no residual meatus or satisfactory tumor load reduction should be achieved. The ratio of satisfactory tumor cell reduction to the initial treatment of all ovarian cancers should be the most important indicator of the level of ovarian cancer diagnosis and treatment in hospitals and countries. In recent years, the satisfaction rate of initial tumor cytoreduction for ovarian cancer has been mostly reported to be 45.5%-62.5%, and some experienced gynecologic oncologists have reported that the satisfaction rate of tumor cytoreduction has reached 91%. The success rate of the procedure is related to both the surgical skill of the attending surgeon and the experience of the entire team involved in the procedure. For patients with advanced disease who are considered to have no chance of satisfactory decompression at a lower level hospital, surgical satisfaction rates of 71%-76% can be achieved at higher level institutions. Therefore, they recommend that patients with advanced ovarian cancer should be seen by a medical institution that can achieve a satisfaction rate of 75% or more. Wang Xibo, Department of Gynecology, Weifang People's Hospital The NCCN guidelines recommend that for stage IV patients with distant metastases and stage III patients with large tumors that are difficult to achieve satisfactory reduction, a biopsy histopathological diagnosis can be obtained by laparoscopy or fine needle aspiration, or when a gynecologic oncologist with specialized training has a high suspicion of ovarian cancer and a positive cytological diagnosis of ascites aspiration, several courses of chemotherapy, i.e. neo-adjuvant chemotherapy, should be administered first. neoadjuvant chemotherapy, followed by initial intermittent tumor cytoreductive surgery. Neoadjuvant chemotherapy can reduce the difficulty of tumor cytoreduction, improve the satisfaction rate of surgery, and reduce the intraoperative and postoperative morbidity and mortality to some extent, but it does not prolong the survival of patients, and often results in higher incidence of drug resistance and prolong the overall treatment time of patients, thus causing a decrease in their quality of life. Therefore, neoadjuvant chemotherapy should not be used as the conventional treatment of choice for advanced ovarian cancer. However, neoadjuvant chemotherapy appears to prolong tumor-free survival in elderly patients with advanced ovarian cancer over 70 years of age.