“…Spread of ovarian cancer to certain key anatomic structures would either increase the complexity of surgery or prelude cytoreductive surgery since complete cytoreduction becomes unlikely. 15,18,20,25 In a setting of ovarian cancer or primary peritoneal cancer, these include thick (> 2 cm) sheet like subphrenic disease, disease in the fissures for falciform ligament and ligamentum teres, infiltrating liver and splenic surface deposits >2 cm, lesser sac, porta hepatis and porto-caval space, biliary obstruction, lesser omentum, perigastric disease encasing the stomach and the left gastric artery, disease in the root of mesentery, small bowel serosal disease, retroperitoneal spread to perinephric and paranephric space, presacral space, pelvic side wall infiltration, and large paramedian abdominal wall disease (►Table 4, ►Figs. 7-11).…”