A review of second-look laparotomy for ovarian cancer |
| |
| Authors: | J M Cain P E Saigo V K Pierce D G Clark W B Jones D H Smith T B Hakes M Ochoa J L Lewis |
| |
| Affiliation: | 1. Department of Surgery (Gynecology Service), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021 USA;2. Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021 USA;3. Department of Medicine (Solid Tumor Service), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021 USA;1. Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy;2. Università Cattolica Del Sacro Cuore, Roma, Italy;3. Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Gineco-patologia e Patologia Mammaria, Roma, Italy;4. Fondazione Policlinico Universitario A. Gemelli IRCCS, Polo Scienze per Immagini, di Laboratorio e Infettivologiche, Roma, Italy;5. Università Federico II-CEINGE, Biotecnologie Avanzate, Napoli, Italy;1. Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Czech Republic;2. Department of General Surgery, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Czech Republic;3. Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic;4. Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Brno, Czech Republic;1. Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy;2. Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy;3. Laboratory of Clinical Molecular and Personalized Diagnostics, Catholic University of the Sacred Heart, Roma, Italy;4. Laboratory of Clinical Molecular and Personalized Diagnostics, Fondazione "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy;5. Department of Surgical Sciences, Hepatobiliary Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Catholic University of the Sacred Heart, Rome, Italy;6. Division of General Surgery, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Rome, Italy;7. Institute of Histopathology, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Catholic University of the Sacred Heart, Roma, Italy;8. Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria |
| |
| Abstract: | One hundred twenty-seven patients underwent second-look laparotomies from July 1969 to June 1982. To be included in this report they must have met the following criteria: a documented ovarian neoplasm; previous surgery; adequate chemotherapy for cessation if no disease was found; and no X-ray, chemical, or clinical evidence of disease including an exam under anesthesia. Forty-one percent had residual disease at second-look laparotomy. The original stage and the percentage of tumor debulked at initial surgery were inversely related to the likelihood of finding residual disease. Age, histologic type and grade, and type of chemotherapy did not show a significant relationship with the likelihood of disease persisting. Recurrent tumor was subsequently detected in 16% of patients who had been found to be free of disease at second-look laparotomy. Of thirty stage III and IV patients treated with combinations containing cis-platinum, 10 (33%) had recurrences. This rate of recurrence was significantly greater than the 17.6% recurrence rate in 17 patients with Stage III and IV disease whose chemotherapy consisted of single alkylating agents or with combinations without cis-platinum. Twenty patients underwent a third-look laparotomy after completion of additional chemotherapy. Nine were found to have no residual disease. Two of the nine (22%) subsequently had recurrence of disease. Three of the eleven patients with persistent disease at the time of a third-look laparotomy underwent a fourth-look laparotomy. All were found free of disease and none have recurred. Six (55%) of those with persistent disease at the third-look laparotomy have died despite continued therapy. The ability to successfully treat some patients with persistent disease continues to be a justification for the use of a second-look laparotomy. However, the high rate of recurrence after cessation of treatment following the finding of no residual disease raises the question of whether it is appropriate to discontinue all therapy at this time. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
