Surgery and chemotherapy are the standard of care for epithelial ovarian cancer, and it is well established that survival outcomes are improved when the surgery results in no or optimal (less than 1 cm) residual disease. However, for patients with bulky disease that may require extensive or radical procedures to accomplish this goal, the use of neoadjuvant chemotherapy followed by interval debulking surgery to simplify the surgery and minimize morbidity has been suggested. Arguably, this is only ideal if this process produces survival outcomes equivalent to those of primary debulking surgery. The purpose of this article is to review the data surrounding this controversial topic.