Objective: To compare the survival and perioperative outcomes of laparoscopic and open debulking surgery for advanced ovarian cancer (EOC). Design: Retrospective cohort study. Setting: Tertiary referral centre. Population: Patients with high-grade serous EOC (FIGO stage III-IV) undergoing debulking surgery between April 2008 and June 2018. Methods: Patients were identified in the hospital database, and their electronic charts were reviewed. The data were evaluated by R software and univariate and multivariate analyses. Main outcome measures: Overall survival (OS), progression-free survival (PFS) and surgical outcomes. Results: There were imbalances in the baseline indexes of ascites volume, Fagotti score and NACT administration between the two groups (P<0.001). After adjustment with the inverse probability of treatment weighting (IPTW) propensity score method, the overall balance of the covariates was improved significantly. The survival analyses both before and after weighting showed that there was no difference in OS or PFS between the two groups. Multivariate Cox regression showed that the surgical approach was not an independent factor for survival. Stratified analyses showed that there was no difference in OS or PFS between the subgroups, regardless of whether they were grouped by treatment strategy (primary and interval debulking) or by reduction effect (R0 and non-R0)). The blood loss volume, complication rate and ICU admission rate were lower in the laparoscopy group than in the open group (p<0.001). Conclusions: Compared with laparotomy, laparoscopic debulking surgery can achieve similar survival outcomes and lead to better perioperative outcomes. However, these outcomes warrant further evaluation in randomized clinical trials.