Secondary surgery after failure of primary treatment is a promising and reasonable option only for patients with a relapse-free interval of at least 6-12 months who should have ideally achieved a tumor-free status after primary therapy. As after primary surgery, size of residual tumor is the most significant predictor of survival after secondary surgery. Even in the case of multiple tumor sites, complete removal of the tumor can be achieved in nearly 30% of the patients. Treatment results are much better in specialized oncology centers with optimal interdisciplinary cooperation compared with smaller institutions. Chemotherapy can be used both for consolidation after successful secondary surgery and for palliation in patients with inoperable recurrent disease. Since paclitaxel has been integrated into first-line chemotherapy, there is no defined standard for second-line chemotherapy. Several cytotoxic agents have shown moderate activity in this setting, including treosulfan, epirubicin, and newer agents such as topotecan, gemcitabine, vinorelbine, and PEG(polyethylene glycol)-liposomal doxorubicin. Thus, the German Arbeitsgemeinschaft Gynakologische Onkologie (AGO) has initiated several randomized studies in patients with recurrent ovarian cancer in order to define new standards for second-line chemotherapy.