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Background and Aims Preoperative anxiety is a critical yet often under-assessed factor that may influence postoperative pain and recovery. Women undergoing gynecologic oncology surgery often report higher anxiety levels due to concerns about fertility, body image, and uncertainty. This study aimed to investigate the relationship between preoperative anxiety and postoperative pain severity, opioid use, and hospital stay in patients undergoing laparoscopic gynecologic oncology surgery.Methods Female patients aged 18–80 years with ASA I–III, undergoing elective laparoscopic oncologic gynecologic surgery, were enrolled in this prospective observational study. State-Trait Anxiety Inventory (STAI-I and STAI-II) was administered preoperatively; STAI-I was repeated 24 hours postoperatively. Postoperative pain was assessed via VAS at 0, 2, 6, and 24 hours. Total opioid consumption (in morphine equivalent), time to first analgesia, and length of hospital stay were recorded. Statistical analysis was performed using SPSS 22.0.Ethics Approval: This study was approved by the Etlik City Hospital Ethics Committee with approval number AEŞH-EK-2025–148, dated 21.05.2025.Results Higher preoperative STAI-I scores were significantly associated with increased VAS scores at 2 and 6 hours. Patients with elevated anxiety required earlier analgesia and more frequent use of tramadol. A significant correlation was also found between anxiety levels and total opioid consumption. No difference was observed in length of hospital stay.Conclusions Preoperative anxiety may predict early postoperative pain and opioid demand. Routine anxiety screening and personalized interventions may enhance recovery and patient comfort within ERAS-based care, even in minimally invasive gynecologic oncology surgery.