Abstract: Objective: Hysterectomy and salpingo-oophorectomy is the standard surgical procedure for treatment of advanced primary epithelial ovarian cancer (EOC). At this point in time, an aggressive surgical approach to the disease in the pelvis is thought to be of benefit even though residual disease may remain behind beneath the hemidiaphragms and within the abdomen. Methods: Data was gathered at reoperative cytoreductive surgery (CRS) on EOC patients who had recurrence following hysterectomy. At the time of this cytoreduction, all structures within the abdomen and pelvis were visualized. Disease recurrence at 23 sites was recorded in all patients. Results: The incidence of recurrence/progression of EOC histologically documented at anatomic sites at the time of reoperation in 20 patients were right subphrenic space (70%), residual greater omentum (65%) and rectosigmoid colon (65%). Anatomic sites that would be cleared of EOC by hysterectomy showed an incidence of recurrence as follows: prior abdominal incision (55%), visceral surface of the bladder (50%), distal left ureter (50%), vaginal cuff (50%) and distal right ureter (35%). Conclusions: Progression of EOC beneath the right hemidiaphragm and within the mid-abdomen along with recurrence at crucial anatomic sites cleared of cancer at the time of hysterectomy were documented. Hysterectomy will result in tumor cell entrapment and enhance disease recurrence at sites of surgical trauma. Hysterectomy is not recommended unless if part of a procedure where all subdiaphragmatic, abdominal, and pelvic cancer are resected.