Epithelial ovarian cancer (EOC) remains the most lethal gynecological malignancy worldwide, primarily due to late-stage diagnosis, limited early screening tools, and the aggressive nature of the disease. Increasing global efforts have been directed toward harmonizing clinical guidelines and ensuring equitable access to optimal care. This narrative review provides a comprehensive overview and critical comparison of the most recent international guidelines for ovarian cancer management, emphasizing similarities and discrepancies. Each section examines diagnostic, surgical, and therapeutic recommendations across all disease stages—from prevention to recurrence. Emerging advances that are reshaping the management of EOC such as preclinical models and the application of artificial intelligence are also discussed. This work provides an updated and practical synthesis to support clinicians, researchers, and policymakers in optimizing ovarian cancer management and guiding future research priorities in precision oncology.

The best surgical timing for advanced epithelial ovarian cancer, whether primary debulking surgery or interval debulking surgery, remains debated. Recent data, including the preliminary ones from TRUST trial, necessitates an updated critical evaluation. A systematic search of PubMed identified only randomized controlled trials comparing interval debulking surgery versus primary debulking surgery in patients with newly diagnosed advanced ovarian cancer. Primary outcomes included overall survival (OS) and progression-free survival (PFS). A random-effects meta-analysis, meta-regression, cumulative synthesis, and leave-one-out influence analysis were performed. A total of 2303 patients were included. Compared to primary debulking surgery, interval debulking surgery was associated with lower rates of postoperative complications (OR = 0.37; 95 % CI: 0.18-0.79; P = 0.01) and mortality (OR = 0.23; 95 % CI: 0.09-0.57; P = 0.002). Meta-analysis showed higher rates of complete cytoreduction with interval debulking surgery (OR = 3.84; 95 % CI: 2.14-6.91; P < 0.00001) and lower rates of macroscopic residual disease (OR = 0.20; 95 % CI: 0.13-0.30; P < 0.00001). Pooled data revealed no significant difference in OS (HR = 0.95; 95 % CI: 0.87-1.04; P = 0.26) or PFS (HR = 0.94; 95 % CI: 0.85-1.03; P = 0.16). Subgroup analyses by stage and residual disease confirmed similar survival outcomes. The meta-regression results suggested that even in trials with very high complete cytoreduction rates, no clinically meaningful OS benefit was observed for upfront surgery. In conclusion, interval debulking surgery offers comparable survival outcomes to primary debulking, with reduced perioperative morbidity and mortality, supporting its role as a valid surgical alternative. PROSPERO REGISTRATION NUMBER: CRD420251105308.

Ovarian cancer (OC) remains the most lethal gynecologic malignancy worldwide, largely due to late-stage diagnosis and the absence of effective screening strategies. As a result, primary prevention is a critical approach to reducing disease burden. This narrative review summarizes current evidence on modifiable lifestyle, reproductive, and environmental factors associated with OC risk, based on a comprehensive PubMed, MEDLINE, Scopus, and Web of Science search conducted through April 2026. Consistent protective associations have been reported for reproductive factors, including parity, breastfeeding, oral contraceptive use, salpingectomy, and tubal ligation. Among lifestyle factors, excess body weight is modestly associated with increased OC risk, while evidence regarding physical activity remains inconclusive. Diets rich in fiber and aligned with a Mediterranean pattern appear protective, potentially through hormonal modulation and anti-inflammatory effects. In contrast, pro-inflammatory diets high in trans fats and refined carbohydrates may increase risk, whereas omega-3 fatty acids show potential protective benefits. Chronic pelvic inflammation, particularly related to Chlamydia trachomatis infection, has been linked to elevated epithelial OC risk. Smoking demonstrates a dose–response association with mucinous tumors. Environmental exposures, including genital talc use and endocrine-disrupting chemicals such as phthalates and bisphenols, have linked to a possible, albeit modest, increase in risk, although the causal mechanisms remain uncertain. Although individual associations are generally modest, their cumulative population impact may be substantial. Integrating lifestyle-based prevention strategies into gynecologic practice and public health initiatives could represent a cost-effective approach to reducing OC incidence and improving women’s health outcomes.