Second-look and second surgery: Second chance or second best?

Abstract

About 40 years ago, second‐look laparotomy (SLL) was introduced to evaluate, surgically and pathologically, primary treatment in case a clinical complete remission was obtained in ovarian cancer patients. But does SLL increase the disease‐free or overall survival? Important technical aspects of the procedure as: how many biopsies should be taken, can lapraoscopy be replaced by laparotomy and should complete lymphadnectomy be performed at SLL, are still not clarified. This and maybe even more important issues, are disputed in literature: for instance, should a SLL be done at all, or should a SLL be performed in order to do a secondary cytoreduction in case tumour is found at the operation. If clinical remission is reached in more than 50% of the patients with advanced disease, tumour still can be found at SLL. If no tumour is found at SLL, macroscopically or microscopically, the operation is redundant. Apart from this, the recurrence rate after such a “negative SLL” is about 35%. Whether tumour found at SLL should be removed will depend on the fact if the tumour still is responsive to chemotherapy. To minimise the chance of tumour resistance, secondary surgery should be done as early as possible during treatment. Therefore, an interval debulking will be the intervention of choice. So, as long as there is no evidence that SLL increases the survival in ovarian cancer patients, it should be done in a research setting only. Also, the usefulness of secondary surgery for recurrent disease mainly depends on the chemo‐sensitivity of the tumour. After a complete remission, which lasts for more than a year, complete secondary cytoreduction, again followed by chemotherapy, improves survival. Semin. Surg. Oncol. 19:54–61, 2000. © 2000 Wiley‐Liss, Inc.

Prognostic significance of second-look laparotomy for surgically confirmed early-stage epithelial ovarian cancer: a multicenter retrospective study

“…[9][10][11] Also, many parameters have been reported to correlate with the result of SLL, such as stage, histologic subtype, differentiation, age of the patient, and residual disease after the first cytoreductive operation. 5,20 In the present study, there were only two cases of positive SLL findings among 30 patients with early-stage ovarian cancer who received SLL (6.7%). Several authors have reported higher rates of positive SLL findings, ranging between 14% and 26%, in early-stage patients.…”

“…5,17,18 Some authors have reported that SLL has a positive effect on the survival of the patients, 6,19 although many others claimed that SLL did not increase the disease-free or overall survival. [9][10][11] Also, many parameters have been reported to correlate with the result of SLL, such as stage, histologic subtype, differentiation, age of the patient, and residual disease after the first cytoreductive operation.…”

“…1,3,4 Second-look laparotomy (SLL) defined as "a systematic surgical re-exploration in asymptomatic patients who have no clinical evidence of tumor following initial surgery and completion of a planned program of chemotherapy for ovarian cancer," has been used widely to assess the status of disease and response to chemotherapy. 5 Many studies have evaluated the prognostic significance of SLL. Some authors demonstrated that this invasive intervention has some positive effect on the survival of the patients.…”

“…However, the authors of most of the other studies claimed that SLL did not improve the disease-free or overall survival, and its value has begun to be questioned, especially in the early stage. 5,8,9 Rubin et al 10 reported that nearly 50% of the patients with negative SLL findings developed recurrences during the follow-up, and there is still no effective salvage therapy for those who have persistence or recurrence. 11 In early-stage patients, Walton et al 12 reported that SLL did not influence the rate of disease relapse.…”

Intérêt de la tomographie par émission de positons au [18F]-fluorodésoxyglucose dans le diagnostic, le bilan d'extension et la recherche de récidive des cancers gynécologiques et mammaires

“…Trente-cinq pour cent des patientes sans lésion macroscopique ou microscopique retrouvée lors de la laparotomie de réévaluation ont développé une récidive dans l'année suivant le geste chirurgical, d'après l'étude de Sijmons et Heintz [34]. En fait, lors de cette intervention, l'éva-luation exacte de la maladie résiduelle peut être difficile du fait des remaniements secondaires à la première intervention chirurgicale, et des lésions de petite taille non visibles par le chirurgien peuvent être laissées en place.…”