Is less already enough? Minimally invasive interval debulking surgery for advanced ovarian cancer

Minimally invasive surgery (MIS), including laparoscopy and robotic-assisted techniques, has increasingly been explored as an alternative to laparotomy for interval debulking surgery (IDS) following neoadjuvant chemotherapy (NACT) in advanced epithelial ovarian cancer (EOC). This systematic review evaluates the current evidence on the surgical feasibility, patient selection, perioperative outcomes, and oncological safety of MIS in this setting. Following PRISMA guidelines, a systematic search of PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov was conducted for studies published between January 2015 and June 2025. Eligible studies included prospective and retrospective cohorts, randomized trials, and meta-analyses reporting outcomes of MIS for IDS in FIGO stage III-IV EOC patients after NACT. Data extraction and risk of bias assessment were independently performed by two reviewers. Sixteen studies involving 9299 patients were included. MIS demonstrated high rates of complete cytoreduction (R0: 85-100 %) in selected patients, with significantly lower estimated blood loss, shorter hospital stays, fewer major complications, and earlier resumption of chemotherapy compared to open surgery. Operative times were generally longer, and conversion rates varied by tumor burden and selection criteria. Oncologic outcomes, including progression-free and overall survival, were comparable between MIS and laparotomy across multiple studies. Robotic-assisted IDS showed similar feasibility and outcomes, but evidence for this approach was mainly derived from small, retrospective cohorts. In appropriately selected patients and experienced centers, MIS for IDS appears to be a feasible and oncologically safe alternative to open surgery, offering meaningful perioperative benefits. Further randomized studies are needed to confirm long-term oncological equivalence.