Objective: To investigate whether preoperative diagnostic laparoscopy can prevent furtile primary debulking surgery (PDS) by predicting optimal cytoreduction (residual disease < 1 cm) in patients with advanced-stage ovarian cancer. Methods: We retrospectively analyzed 307 patients with advanced-stage ovarian cancer from January 2010 to September 2017. According to the use of diagnostic laparoscopy, we stratified patients into two groups. In 121 patients, laparoscopy was used to guide selection of PDS or neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS) and in 186 patients, primary treatment was decided by CT or surgeons discretion. The primary outcome was futile PDS or the rate of non-HGSC patients underwent NAC/IDS. Results: In the decision by laparoscopy group (group 1), 37 (30.6%) of 121 patients underwent PDS versus 112 (60.2%) of 186 patients in the decision by CT or surgeons discretion group (group 2). Furtile laparotomy (residual disease >1 cm) occurred in 1 (3%) of 121 patients in group 1 versus 19 (17%) of 186 patients in group 2 (p=0.02). The rate of patients who underwent NAC with non-HGSC was higher in group 2 than group 1 (13.5% vs. 6.0%, p=0.051). However, there were no significant differences in postoperative morbidity and radical surgery rate. Kaplan-Meier analysis showed no between-group differences in progression-free or overall survival (p=0.218 and 0.482, respectively). Conclusion: Diagnostic laparoscopy is an effective tool to select patients in whom PDS will be successful in achieving <1 cm of residual disease. Therefore, diagnostic laparoscopy should be considered in the diagnostic work-up of women with ovarian cancer to guide treatment selection for either PDS or NAC/IDS.