Abstract: To determine the factors affecting primary optimal surgery and the clinical significance of neoadjuvant chemotherapy ( NAC ) on advanced epithelial ovarian cancer. Methods: From January1996 to December 2008 , 92 cases with advanced epithelial ovarian cancer ( stages IIIc-IV ) were retrospectively analyzed. NAC was performed in 18 cases, while the rest underwent primary cytoreductive surgery followed by platinum-based chemotherapy. Results: Suboptimal debulking was statistically associated with patients having complications ( P = 0.022 ), cavity hydrops ( P = 0.011 ), CA125 > 1000 U/L ( P = 0.03 ), and liver or pulmonary metastasis ( P = 0.031 ). The total effective rate of NAC was 66.7%. The rate of gross excision was significantly higher ( P = 0.022 ). It also shortened the remaining time of the drain pipe ( P = 0.011 ), decreased ascites ( P = 0.005 ), and blood loss ( P = 0.048 ). However, the time spent in surgery, blood transfusion, hospital stay, and overall survival rate showed no significant difference ( P > 0.05 ). Conclusions: NAC can enhance the gross excision rate of advanced ovarian cancer and decrease the incidence of intraoperative and postoperative complications. It may also improve the prognosis of patients with advanced ovarian cancer.