Optimal cytoreduction is less likely if patients have the following: Poor performance status Age > 60 years American Society of Anesthesiologists physical status 3 or 4 Medical comorbidities Poor nutritional status Extra-abdominal disease Large tumor bulk Involvement of large bowel Metastases to retroperitoneal lymph nodes above the renal vessels and > 1 cm in largest dimension Parenchymal liver involvement A preoperative CA 125 > 500 U / mL The Fagotti score, based on seven laparoscopic findings, can help predict the likelihood of optimal cytoreduction in patients with advanced ovarian cancer.