Objective: Surgery is the cornerstone of management in ovarian cancer. However, in high-risk and elderly patients there is a tendency for less aggressive surgery upfront. The aim of this study was to review cytoreductive surgery, with focus on complications and outcomes in patients with multiple surgical risk factors. Study design: Charts of patients with ovarian cancer from 1998 to 2002 were retrospectively reviewed. Results: One hundred and forty patients were treated for ovarian cancer. Sixty-three patients (45% ) were elderly (≥ 65 years), and 69 patients (49% ) had comorbidities. Optimal debulking (≤ 1 cm) was achieved in 123 patients (88% ). There was no significant relation between complications and type of procedure, elderly age, comorbidities, or transfusions. Optimally debulked patients had a significantly longer survival than patients with suboptimal debulking (P < .001). Conclusion: Aggressive optimal cytoreduction can be achieved in the majority of patients with multiple surgical risk factors and is associated with a low complication rate. Objective: Surgery is the cornerstone of management in ovarian cancer. However, in high-risk and elderly patients there is a tendency for less aggressive surgery upfront. The aim of this study was to review cytoreductive surgery, with focus on complications and outcomes in patients With multiple surgical risk factors. Study design: Charts of patients with ovarian cancer from 1998 to 2002 were retrospectively reviewed. Results: One hundred and forty patients were treated for ovarian cancer. Sixty-three patients (45%) were elderly (≥ 65 years ), and 69 patients (49% ) had comorbidities. Optimal debulking (≤ 1 cm) was achieved in 123 patients (88% ). There was no significant relationship between complications and type of procedure, elderly age, comorbidities, or transfusions. Optimally Debulked patients had a significantly longer survival than patients with suboptimal debulking (P < .001). Conclusion: Aggressive optimal cytoreduction can be achieved in the majority of patients with multip Le surgical risk factors and is associated with a low complication rate.