BLI made it possible to visualise disease progression including metastatic dissemination and development of distal metastasis in liver and lungs, and the intensity of the Temozolomide bioluminescence signal correlated with the tumour load. We subsequently developed a surgical procedure permitting maximum cytoreduction, confirmed by BLI. In order to standardise the methodology and surgical procedure used, at the time of surgery all mice were operated at a lower stage of disease than most human patients at their time of clinical presentation. Analogous to what has been observed clinically, surgery was the treatment modality with the greatest impact on the outcome variables when compared to chemotherapy. The group of mice treated with debulking surgery followed by adjuvant chemotherapy was, similar to observations in human studies, found to have the longest mean survival time. After maximal cytoreductive surgery, where the primary tumor is removed, there is no evidence of either local or distant metastases in patients. This was illustrated also in our model, both by the macroscopic findings after surgery and by the BLI-analysis performed after the procedure. As all mice were macroscopic tumor free after the cytoreductive surgery it was interesting to note the rather large discrepancies in disease development in the surgical cohorts with variation of 62.7 weeks. Although we cannot rule out that sufficient cytoreduction was not achieved and also the presence of occult metastases not visible to the surgical team or BLI undetectable, micro-metastasis were the most likely cause of the early relapses. To circumvent this problem clinically, imaging has become an important facet of presurgical planning and postoperative followup. More recently, the emergence of fluorescence-based imageguided surgery incorporating a fluorescently labeled biomarker of an overexpressed membrane-bound protein or receptor has been successfully translated to clinical surgery of ovarian cancer. Preclinical development of image-guided surgery has also been performed with human cell lines inoculated subcutaneously and within the peritoneal cavity. While these models are not an accurate paradigm of human ovarian cancer, the application of our surgical model will now permit the realistic evaluation of image-guided surgery techniques combined with targeted drug therapy/chemotherapeutics prior to clinical translation. Orthotopic nude mouse models have been developed for ovary carcinoma with surgical implantation of tissue but with less infiltrative and invasive growth compared to what is seen in our model. Although inclusion of primary patient cells isolated from ascites is a natural step in the evolution of our orthotopic model, a recent study demonstrates the complications of phenotypic heterogeneity and instability of human ovarian tumour cells.