The Role of Douglasectomy Instead of Random Biopsies in the Surgical Treatment of Presumed FIGO Stage I Ovarian Cancer

<b>Background/Objectives:</b> Douglasectomy is defined as the removal of the pelvic peritoneum of the entire pouch of Douglas. In presumed FIGO stage I ovarian cancer, isolated microscopic cancer cells might disseminate from the ovaries to their neighboring pelvic peritoneum. However, a simple hysterectomy with bilateral salpingo-oophorectomy and a staging procedure is the standard of care. This study aims to investigate the safety and feasibility of douglasectomy compared to random pelvic biopsies, and it is based on the survival of patients with early ovarian cancer. <b>Methods:</b> We retrospectively analyzed the records of patients with presumed 2018 FIGO stage I ovarian cancer who underwent surgery in the 1st Department of Obstetrics and Gynecology Clinic from 2012 to 2022. Patient characteristics and oncological and follow-up information were collected. <b>Results:</b> A total of 88 patients were categorized into two groups, namely Group A (27 patients) with douglasectomy and Group B (61 patients) with random biopsies. There was no statistically significant difference in age, BMI, comorbidities, FIGO stage, intraoperative blood loss, and ICU admittance between the two groups. Conversely, patients with en bloc hysterectomy-douglasectomy had statistically significant higher pre-operative CA-125 values, surgery duration, rate of postoperative complications, and hospital stay. Concerning survival rates, there was a statistically significant difference in disease-free survival (<i>p</i> = 0.033), but no difference was observed in overall survival (<i>p</i> = 0.66). <b>Conclusions:</b> En bloc removal of the pelvic peritoneum of the entire pouch of Douglas with the uterus is a safe and feasible technique during surgery for early ovarian cancer, which leads to improved disease-free survival and local control.