ObjectiveTo assess the impact of surgery and chemotherapy on survival in women with epithelial ovarian cancer.MethodsFive hundred twenty-three women were treated at the same institution in 1977–1990. All pertinent data from patient files were collected by the author. Operations were performed by senior surgeons of the hospital. Cumulative survival and survival analysis with covariates (Cox model) were calculated. Multivariate analysis was used to assess the impact of surgery and chemotherapy on survival in 244 patients who had stage III epithelial ovarian cancer.ResultsThe overall cumulative 5-year survival for patients with epithelial ovarian cancer treated in the period 1977–1980 was significantly (P= .001) lower (33%) than that for patients treated in 1981–1985 (49%) or 1986–1990 (46%). The 5-year survival of women with stage III ovarian cancer improved from 10% in 1977–1980 to 27% in 1986–1990. In these stage III patients, chemotherapy containing cisplatin was associated with better survival than other chemotherapies, both in patients with optimal surgery (1.0− versus 2.9-fold risk of death) and in those with suboptimal surgery (1.4− versus 1.7-fold risk of death).ConclusionsThe results of this study suggest that cisplatin may be more important than surgery in improving survival in stage III epithelial ovarian cancer. Thus, epithelial ovarian cancer, at least in advanced stages, is a disease not curable with aggressive surgical procedures alone.