The role of second-look laparotomy in the long-term survival in ovarian cancer

Background: To elucidate the role of second-look laparotomy in themanagement of ovarian cancer patients, we retrospectively reviewed ourexperience with this procedure in epithelial ovarian cancer patients.Patients and methods: The hospital records of 617 patients with advancedovarian cancer were reviewed. The 308 patients who underwent second-looklaparotomy were followed from four to 18 years with a median follow-up of 12years after start of primary chemotherapy.Results: Patients who achieved pathological complete response (PCR),microscopic partial response (PPR mic.), macroscopic partial response (PPRmac.), stable disease (PSD), and progressive disease (PPD) at second-looklaparotomy had a median survival time of 149, 39.5, 24, 14, and eight months,respectively. Secondary surgical cytoreduction could be performed only in 101patients with macroscopic persistent disease. The group of all patients withsecondary tumor debulking had no survival advantage compared with the groupof patients with PPR mac., PSD, and PPD, unable to have secondarycytoreduction. Patients left with no tumor after second-look laparotomy didnot survive as long as patients who achieved PCR and PPR mic. at second-looklaparotomy. Factors prolonging survival after second-look laparotomy includedyounger age, good pre-treatment performance status, smaller primary residualtumor size, longer interval between start of chemotherapy and second-looklaparotomy, and the pathologically proven CR or PR mic.Conclusion: Second-look laparotomy appears to have a minor role in theroutine management of ovarian cancer patients, especially in the context ofthe limited effectiveness of second-line therapy. This procedure should belimited to clinical treatment protocols to determine effectiveness of newagents.