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Outcome After Laparoscopic Compared to Open Interval Debulking Surgery for Advanced Stage Ovarian Cancer: A Systematic Review and Meta-Analysis
by
, , and
Jana von Holzen
1,
Franziska Siegenthaler
2,
Noah Locher
2,
Christine Baumgartner
3,
Sara Imboden
2,
Michael David Mueller
2 and
Flurina Annacarina Maria Saner
2,* 1
University of Bern, 3012 Bern, Switzerland
2
Department of Gynaecology and Obstetrics, Bern University Hospital, Faculty of Medicine, University of Bern, 3010 Bern, Switzerland
3
Department of Infectious Diseases, Bern University Hospital, Faculty of Medicine, University of Bern, 3010 Bern, Switzerland
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(23), 3858; https://doi.org/10.3390/cancers17233858 (registering DOI)
Submission received: 30 October 2025
/
Revised: 26 November 2025
/
Accepted: 28 November 2025
/
Published: 30 November 2025
(This article belongs to the Special Issue Primary and Recurrent Gynecological Cancer: Epidemiology, Management and New Therapies)
Simple Summary
This study looked at whether keyhole (minimally invasive) surgery is as safe and effective as open abdominal surgery for women with advanced ovarian cancer who have already received chemotherapy to shrink their tumours. Researchers reviewed 14 studies involving over 16,000 patients. They found that women who had minimally invasive surgery were slightly more likely to have all visible cancer removed and had similar survival rates compared to those who had open surgery. Patients who underwent the less invasive approach also had fewer complications, lost less blood, stayed in the hospital for a shorter time, and could start further chemotherapy sooner. These results suggest that minimally invasive surgery can be a safe and effective option for selected patients. However, more large, well-designed studies are needed to confirm these findings and to identify which women will benefit most from this approach.
Abstract
Background/Objectives: This systematic review and meta-analysis evaluates the oncological safety and outcomes of minimally invasive versus open interval debulking surgery after neoadjuvant chemotherapy in advanced ovarian cancer, addressing whether laparoscopy represents a safe alternative to the standard open procedure. Methods: The Ovid/Medline, Pubmed, and Cochrane databases were systematically screened for studies investigating surgical resection status and/or patient survival after laparotomy compared to minimally invasive interval debulking surgery for FIGO stage III-IV ovarian cancer. A meta-analysis was performed using a random-effects model and risk of bias was assessed. Results: Overall, 14 observational and randomized studies published between 2015 and 2024 with a total of 16,578 patients (4310 laparoscopy and 12,268 laparotomy) were included. A complete cytoreduction to no visible tumour was achieved significantly more often after minimally invasive surgery compared to laparotomy (RR = 1.12; 95% CI [1.01, 1.23]; p = 0.03). Overall survival showed no significant difference between the two groups (HR = 0.81; 95%CI [0.64, 1.04]); progression-free survival was significantly more common after laparoscopy (HR = 0.67; 95% CI [0.48, 0.94]; p = 0.02; I2 = 55%; p = 0.07). Patients undergoing minimally invasive surgery experienced significantly fewer postoperative complications (RR = 0.50; 95% CI [0.33, 0.76]; p = < 0.001), a lower mean blood loss (165 mL vs. 325 mL; SMD −0.58, 95% CI [−0.82, −0.35]; p = < 0.001), a shorter mean hospital stay (3 days vs. 5 days; SMD −0.79, 95% CI [−1.06 , −0.52], p = < 0.001), and a faster initiation of adjuvant chemotherapy (mean 25 ± 32 days vs. 33 ± 28 days). Conclusions: This study indicates that laparoscopic interval debulking surgery is an oncologically safe alternative in selected patients with advanced-stage ovarian cancer. However, randomized controlled trials should confirm these findings as certainty of evidence is low and residual confounding cannot be excluded. Trial registration: PROSPERO Identifier CRD42024524725.
