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The varied application of surgery to the initial treatment of 908 cases of primary ovarian cancer is analysed. In patients with advanced disease (FIGO Stages IIb, III and IV) 256 (46%) of 555 women achieved minimal residual disease status by primary surgery and this proportion fell to 24% when only stages III and IV were considered; of these cases 7% underwent adjunctive intestinal resection or urinary tract surgery. Although not in a clinical trial situation the women achieving minimal residual disease status before chemotherapy survived better in the short term, although long-term survival remained disappointing. In early disease 3% of young women have been subjected to hysterectomy and removal of both ovaries. By contrast, in 16% of women over the age of 40 years with early ovarian cancer bilateral oophorectomy was not carried out.