<p>The European Society of Gynaecological Oncology (ESGO) ovarian cancer guidelines provide internationally accepted benchmarks for diagnosis, surgical management, systemic therapy, and quality assurance. Adherence to these standards has been associated with improved surgical outcomes and survival, particularly in high-volume centers. In India, however, implementation of ESGO recommendations remains heterogeneous due to variability in healthcare infrastructure, limited availability of trained gynecologic oncologists, restricted access to advanced diagnostics and targeted therapies, and the absence of uniform national protocols. This expert commentary examines the real-world applicability of ESGO ovarian cancer guidelines in the Indian healthcare setting, drawing on published Indian literature, tertiary-care experience, and existing international guideline frameworks commonly used by surgical oncology specialists. Key challenges to implementation—including surgical expertise, resource availability, training gaps, and quality monitoring—are discussed. The commentary further highlights pragmatic strategies to improve alignment with ESGO standards, such as strengthening multidisciplinary tumor board services, standardizing radiology and pathology reporting, expanding specialist training programs, and adopting quality indicator–based audits. Contextualized implementation of ESGO guidelines, adapted to local resources, has the potential to reduce variability in care and improve outcomes for women with ovarian cancer in India.</p>