Background <p>Approximately 30% of women present in early stage of carcinoma ovary. However, occult metastases may be present even when the disease appears macroscopically confined to the ovaries. Comprehensive surgical staging (CSS) leads to upstaging in up to one-third of clinically early-stage epithelial ovarian cancer (EOC) cases.</p> Purpose of Study <p>To evaluate the pattern of occult metastasis and upstaging rates in patients who underwent CSS for early EOC.</p> Methodology <p>Retrospective audit of patients who underwent primary CSS or restaging for early EOC in in tertiary cancer centre in southern state of India from January 2006 to August 2023 excluding patients with clinical and radiological extraovarian disease and macroscopic peritoneal disease on laparotomy. Patients were evaluated based on findings from peritoneal washings, peritoneal biopsies, and lymph node status.</p> Results <p>76 patients were analysed. 61 underwent primary staging, 15 underwent restaging. Prevalence of occult metastasis was 35.1 percent. Most common site of occult metastasis was peritoneum (11.8 percent). Overall upstaging rate was 23.6 percent (18/76), 2.6 percent (2/76) were Stage IC3, Stage IIA was 6.6 percent (5/76), Stage IIB was 1.3 percent (1/76), Stage III A1 was 5.3 percent (4/76), Stage IIIA2 was 7.8 percent (6/76). The rate of upstaging was highest in high grade serous carcinoma, 13 percent (10/76).</p> Conclusion <p>23.6 percent patients were upstaged due to occult metastasis. Patients with high grade serous carcinoma has highest risk of being upstaged.</p>