Epithelial ovarian cancer comprises 90% of all ovarian cancers. Like most other epithelial tumors, epithelial ovarian cancer spreads initially by direct extension into adjacent organs, especially the fallopian tubes, uterus, and contralateral adnexa, and, occasionally, the rectum, bladder, and pelvic sidewall are also invaded. Transcelomic metastases are often associated with the formation of malignant ascites, resulting in raised intra-abdominal pressure and consequent abdominal distention and discomfort, early satiety leading to dietary deficiency, impaired circulation of blood and lymphatic vessels, and respiratory embarrassment secondary to diaphragmatic splinting. This chapter covers the transcelomic journey, rationale for peritonectomy procedures, and procedural complications.