Recurrent ovarian cancer is associated with a poor long-term prognosis and optimal management for this problem is not well defined. The benefits of primary surgical cytoreduction in prolonging survival rates in advanced ovarian cancer have prompted examination of the potential role of secondary cytoreductive surgery in patients with recurrent disease or disease that progresses or stabilizes during primary adjuvant chemotherapy. No randomized clinical trials have been performed to evaluate secondary surgery in these settings. Based on available data, secondary surgery does not appear to improve survival in patients whose disease progresses or stabilizes during primary adjuvant chemotherapy and therefore is not recommended. The most promising experience with secondary surgery has been in patients with recurrent disease following optimal primary surgical resection with a recurrence-free interval of at least 1 year. While secondary surgery is feasible, it has not yet been proven to improve survival, as similar survival rates have been reported using chemotherapy alone. Consequently, it is critical to minimize the risk of morbidity through careful patient selection when secondary surgery is used.