Laparoscopy Prior to Laparotomy in Primary Debulking Surgery for Advanced Ovarian Cancer Linked to Improved Survival
Laparoscopy before laparotomy in primary debulking surgery (PDS) for advanced epithelial ovarian cancer (EOC) is associated with improved overall survival (OS), particularly in patients with stage IIIC disease. Despite this potential benefit, the technique remains underutilized, with only 4.2% of cases incorporating laparoscopy. This study was presented at the Society of Gynecologic Oncology 2025 Annual Meeting on Women’s Cancer in Seattle, WA.
Previous studies have demonstrated that laparoscopy prior to laparotomy is linked to lower rates of suboptimal cytoreduction, yet its impact on survival outcomes remains uncertain. Given the importance of achieving optimal debulking in advanced ovarian cancer, this study sought to assess whether the use of laparoscopy in PDS is associated with improved OS and other key surgical outcomes.
Researchers conducted a retrospective analysis of data from the National Cancer Database (NCDB), identifying patients diagnosed with stage IIIC or IV EOC who underwent PDS between 2010 and 2017. The primary outcome was OS, while secondary outcomes included 90-day postoperative mortality, 30-day readmission rates, and length of hospital stay.
Among the 12,532 eligible patients, 529 (4.2%) underwent laparoscopy prior to laparotomy, with utilization increasing from 3.4% to 6.9% during the study period (P < .001). Baseline characteristics, including age, race, insurance status, and comorbidity index, were similar between the two groups. While patients undergoing laparoscopy were less likely to have stage IV disease (21.4% vs 25.2%, P < .05), rates of complete gross resection and extensive surgery were comparable. Postoperative outcomes, including 90-day mortality, 30-day readmission, and hospital stay, showed no significant differences between groups. However, laparoscopy before laparotomy was associated with a significant OS advantage (60.8 vs 51.6 months, P = .012). A stage-stratified analysis revealed that the survival benefit was observed in stage IIIC disease (64.5 vs 55.2 months, P = .026) but not in stage IV cases.
“Laparoscopy prior to laparotomy is associated with improved overall survival in women with stage IIIC epithelial ovarian cancer undergoing primary debulking surgery,” the authors concluded. “Despite its increasing use, the overall adoption rate of laparoscopy before laparotomy remains low.”
Goncalves N. Utilization of laparoscopy prior to laparotomy in primary debulking surgery for advanced epithelial ovarian cancer: A National Cancer Database analysis. Paper presented at: Society of Gynecologic Oncology 2025 Annual Meeting on Women’s Cancer; March 14-17, 2025; Seattle, WA. Accessed March 11, 2025. https://www.sgo.org/events/annual-meeting/