Aim: to assess the pattern of failure and survival of advanced ovarian cancer patients with microscopic residual disease at secondlook following cytoreductive surgery and platinum-based chemotherapy. Materials and Methods: Nine-five women were retrospectively analyzed. Residual disease after initial surgery was > one cm in 58 (61.1%) patients, first-line chemotherapy was residuum but positive random peritoneal biopsies and/or positive washing (“true” microscopic residual disease) in 79 (83.2%) patients, and a macroscopic residuum which was completely resected (converted complete response) in 16 (16.8%) patients. Results: Eight-one (85.2%) patients developed recurrent disease after a median time of 14 months (range four to 51). The abdomen (29.6%) and the pelvis (28.4%) were the most common sites of failure. Two- and five-year survival after second-look were 78.1% and 31.0%, respectively. The clinical and pathological features with prognostic relevance at presentation (age, histotype, and tumor grade), as well as type of first-line chemotherapy and treatment after second-look were not related to the clinical outcome. There was a trend for a better survival in patients withoptimal primary cytoreduction compared with those with suboptimal primary cytoreduction (five-year survival = 42.7% vs 23.4%). There was no significant difference in survival between the converted complete responders and the patients with “true” microscopic residual disease. Conclusions: These data confirm the unsatisfactory clinical outcome of patients with microscopicresidual disease after first-line chemotherapy and the limited benefit of second-look reassessment.