Laparoscopy Prior to Laparotomy in Primary Debulking Surgery for Advanced Epithelial Ovarian Cancer in the U.S.: A National Cancer Database Analysis

Objective: Previous studies have demonstrated that the use of laparoscopy prior to laparotomy for primary debulking surgery (PDS) in advanced ovarian cancer is linked to lower rates of suboptimal cytoreduction. However, its impact on overall survival remains uncertain. This study aimed to compare overall survival and surgical outcomes between PDS cases initiated with laparoscopy and those without. Methods: We identified patients in the National Cancer Database who underwent PDS for stage IIIC and IV epithelial ovarian cancer between 1 January 2010 and 31 December 2017. Patients were divided into two groups for analysis: cases that were initiated with laparoscopy and those that were not initiated with laparoscopy. The primary outcome was overall survival, while secondary outcomes included 90-day postoperative mortality, 30-day readmission rate, and length of hospital stay. Statistical analyses were performed using SPSS version 29.0. Results: Among 12,532 eligible patients, 529 cases (4.2%) were initiated laparoscopically. Laparoscopy utilization increased from 3.4% to 6.9% over the study period. Rates of complete gross resection were similar between groups. Postoperative outcomes, including 90-day mortality, 30-day readmission, and hospital stay, did not differ significantly. However, laparoscopy was associated with improved overall survival in patients who proceeded to PDS (60.8 vs. 51.6 months, p = 0.012). In stage-stratified analysis, a survival benefit was noted in stage IIIC (64.5 vs. 55.2 months, p = 0.026), but not in stage IV cases. Conclusions: Despite its increasing use, the overall rate of laparoscopy before PDS remains low. Laparoscopy prior to laparotomy is associated with improved overall survival in patients with stage IIIC epithelial ovarian cancer undergoing PDS.