In this study, researchers aimed to evaluate the prognostic utility of combining tumor molecular subtype with computerized tomography (CT) imaging for surgical outcomes following primary cytoreductive surgery in patients with advanced-stage high-grade serous ovarian cancer (HGSOC). The researchers found 129 individuals with HGSOC who had CT scans before surgery and tumor mRNA analysis afterward. On the basis of 6 imaging assessments of anatomic involvement, a continuous CT-score indicative of total disease burden was developed. The mRNA profiling of chemo-naive cancers allowed for the identification of molecular subgroups, with 36% of tumors falling into the mesenchymal (MES) category and 64% into the non-MES subtype. Surgical difficulty and illness persistence were analyzed using multivariate logistic regression and Fischer exact tests. Tumors of the MES subtype were more common in women with higher CT-scores (P=0.014). Macroscopic disease and significant surgical complexity were independently predicted by MES subtypes and a high CT-score. Patients with an MES subtype and high CT-score had an increased chance of having a macroscopic disease (OR = 26.7, 95% CI = [6.42, 187]) and were more likely to undergo high complexity surgery (OR = 9.53, 95% CI = [2.76, 40.6]) compared to patients with a non-MES tumor and low CT-score. The combination of preoperative CT imaging and tumor molecular subtyping allows for identifying a subset of women who are unlikely to have the resectable disease and are, therefore, likely to require high complexity surgery. It is possible that these, in conjunction with other clinical criteria, will help improve predictive resection scores and facilitate treatment planning. The next stage is to look into pre-operative molecular subtyping.