Minimally Invasive Surgery After Neoadjuvant Chemotherapy for the Treatment of Stage IIIC-IV Ovarian, Primary Peritoneal, or Fallopian Tube Cancer, LANCE Trial

Inclusion Criteria:

• Age ≥ 18 years old

• Stage IIIC or IV, high-grade (serous, endometrioid, clear-cell, transitionalcarcinomas), invasive epithelial ovarian carcinoma, primary peritoneal carcinoma, orfallopian-tube carcinoma or pathology consistent with high-grade mulleriancarcinoma.

• Patient is considered by treating physician to be a surgical candidate aftercompletion of 3 to 4 cycles of platinum-based chemotherapy, or an investigationalneoadjuvant regimen given according to protocol, with complete radiologic resolutionof any disease outside the abdominal cavity. Pleural effusions are acceptable perthe local PI's discretion.

• Normalization of CA-125 according to individual participating center reference range (Note: Among patients with a normal CA-125 at initiation of therapy, the CA-125cannot exceed 35 U/mL at the completion of NACT prior to interval debulkingsurgery.) or has a CA-125 value ≤500 and is scheduled to undergo a diagnosticlaparoscopy prior to debulking surgery. a. For patients undergoing diagnosticlaparoscopy, surgeon considers that optimal debulking is feasible either by MIS orlaparotomy.

• Timeframe of < 6 weeks (42 days) from the last cycle of NACT to interval debulkingsurgery. Overall timeframe may be extended per MD Anderson PI discretion.

• ECOG performance status 0-2

• Signed informed consent and ability to comply with follow-up

• Negative pregnancy test by blood or urine (within 14 days prior to surgery)

• Disease free of other active malignancies in the previous five years, except basaland squamous cell carcinomas of the skin

Exclusion Criteria:

• Evidence of tumor not amenable to minimally invasive resection on pre-operativeimaging (CT, PET-CT, or MRI) including but not limited to the following findingsthat may preclude minimally invasive resection per surgeon's assessment. • Failureof improvement of ascites during NACT (trace ascites is allowed) • Small bowel orgastric tumor involvement • Colon or rectal tumor involvement • Diaphragmatic tumorinvolvement • Splenic or hepatic surface or parenchymal tumor involvement •Mesenteric tumor involvement • Tumor infiltration of the lesser peritoneal sac

• History of psychological, familial, sociological or geographical conditionpotentially preventing compliance with the study protocol and follow-up schedule

• Inability to tolerate prolonged Trendelenburg position or pneumoperitoneum as deemedby participating institution's clinicians

• Any other contraindication to MIS as assessed by the clinician