Primary Debulking Surgery Versus Neoadjuvant Chemotherapy in Advanced Ovarian Cancer: A Meta-Analysis of All Randomized Clinical Trials with Subgroup Analysis by Patient Profile

Background: The optimal sequencing of surgery and chemotherapy in advanced epithelial ovarian cancer remains debated. While primary debulking surgery (PDS) has been considered the standard approach, recent randomized trials have questioned its survival advantage over neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). The study aimed to systematically evaluate phase III randomized controlled trials comparing PDS and NACT. Methods: Following PRISMA guidelines (PROSPERO ID 1169057), PubMed and Scopus were systematically searched in October 2025 for phase III randomized clinical trials evaluating cytoreductive strategies in ovarian carcinoma. Only full-text English studies reporting overall survival (OS) or disease-free survival (DFS) were included. Risk ratios (RR) with 95% confidence intervals (CI) were calculated. Results: = 0%). Conclusions: PDS and NACT provide no significant survival outcomes in advanced ovarian cancer. No clear survival benefit for PDS was observed. Refinement of patient selection, integration of predictive biomarkers, and re-evaluation of PDS in the context of HIPEC and Poly-ADP-Ribose Polymerase (PARP) inhibitor use are warranted to guide individualized treatment strategies.