Can Routine Preoperative Endoscopy and Colonoscopy Be Meaningful for the Surgery and Postoperative Course of Patients with Advanced Ovarian Cancer? A Single-Centre Retrospective Cohort Study

Background/Objectives: Bowel resection is often required for complete cytoreduction in advanced ovarian cancer, and some units perform upper gastrointestinal endoscopy and colonoscopy beforehand. We compared the endoscopic biopsy findings with the histopathology of the resected bowel and examined determinants of survival. Methods: Eighty-three consecutive women with FIGO stage III–IV serous ovarian cancer cytoreduced to no macroscopic residual disease between 2015 and 2021 were reviewed retrospectively; all had undergone both examinations and completed adjuvant carboplatin–paclitaxel. Results: Bowel resection was performed in 20 women (24.1%). Serosal involvement was reported in 15 specimens and no tumour in four; mucosal invasion was reported in none (95% CI 0–16.8%). Eighteen patients (21.7%) were biopsied endoscopically; no biopsy was malignant. Over a median follow-up of 72 months, 50 women (60.2%) developed recurrence (28 confirmed histologically and 22 diagnosed from imaging and CA-125; recurrence was ascertained retrospectively, which limits the interpretation of disease-free survival) and 44 (53.0%) died. Recurrence was no more frequent in biopsied than in non-biopsied patients (8/18 vs. 42/65, p = 0.174) or after resection (10/20 vs. 40/63, p = 0.306). Age showed an exploratory association with disease-free (HR 1.03/year, 95% CI 1.00–1.06) and overall survival (HR 1.04, 1.00–1.07). Conclusions: In this cohort, no preoperative endoscopic biopsy was malignant and no resected specimen was reported to show mucosal invasion, supporting a limited role for routine endoscopy in assessing bowel wall involvement; its diagnostic accuracy and its value for excluding a gastrointestinal primary could not be assessed.