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Wehave readwith great interest the article byHeitz et al. (2016), and would congratulate with them for the effort in investigating technical reasons of suboptimal debulking in advanced epithelial ovarian cancer (AEOC). In this study, the Authors suggest that, because of amuch longer median overall survival (OS) in complete/optimally resected patients, pre-operative identification of unresectable sites may help to develop adequate surgical training and to identify patients thatwould better benefit from alternative strategies. Their overall rate of patients unsuitable for primary debulking surgery (PDS) is 30.3%, including women primarily excluded from surgery and those not achieving RT ≤ 1 cm. In the Discussion section, the Authors compare their rates of optimal debulking with those from other experiences (Gallotta et al., 2013; Chi et al., 2009; Aletti et al., 2009), questioning the role of staging-laparoscopy (S-LPS) according to Rome's experience. They refer to the paper published in 2013 (Gallotta et al., 2013), where 50.7% of patients were deemed not eligible for PDS, thus being triaged directly to neoadjuvant chemotherapy (NACT). Moreover, they extrapolate the data to the entire Rome's population, showing a final rate of complete and optimal debulking of 30% and 13.7%, respectively. They conclude “this strategy seems to lead to a selection and separation of patients in different cohorts but without substantially improving outcome”. In the light of these statements, some clarifications are needed.

RE: Pattern of and reason for postoperative residual disease in patients with advanced ovarian cancer following upfront radical debulking surgery