Second-look laparotomy for epithelial ovarian cancer: A reappraisal

Abstract

Although second-look laparotomy (SSL) has been used in the management of ovarian cancer for over three decades, its current clinical use is limited. On average, over 50% of patients with a clinical complete response are noted to have disease at the time of SLL, emphasizing our lack of accurate noninvasive methods for determining pathologic response. Although findings at SLL have some prognostic significance, there is no definitive evidence that those patients undergoing SLL have improved survival, and even 50% of patients with negative findings at SLL have recurrences. The lack of survival advantage for patients enduring SLL highlights the need to identify consistently effective salvage and consolidation regimens. Few published studies provide definitive evidence regarding efficacy of treatment. Prospective, randomized, controlled trials are needed to evaluate the various therapies available. In general, the performance of SLL should be confined to those patients enrolled in clinical trials.

Decreased intraperitoneal disease recurrence in epithelial ovarian cancer patients receiving intraperitoneal consolidation treatment with yttrium‐90‐labeled murine HMFG1 without improvement in overall survival

“…Gaducci et al and Bolis et al found similar relapse rates 5,11 while studies with slightly longer follow-up have reported higher recurrence rates, 52% and 64%. 4,12,13 In our control group, 89% of the women demonstrated IP disease at time of first recurrence, which is similar albeit modestly higher than IP recurrence rates reported elsewhere. 5,14 On the other hand, the incidence of recurrent disease localized in the retroperitoneal lymph nodes was lower in this study than reported elsewhere.…”

“…5,14 The discrepancy is likely due to inclusion of women with lower stage disease in our study since the risk of lymph node involvement rises with advanced stage disease to more than 50%. 4,15 The study population of the international phase III trial 10 comprised patients with FIGO stage Ic-IV while studies performed by Gaducci et al and Rubin et al were limited to patients with FIGO stage III and IV. 5,14 Significantly, fewer IP recurrences were seen in the active treatment arm.…”

“…2,3 In the majority (82%) of the patients recurrence is seen within the peritoneal cavity, and in 12% it occurs in the retroperitoneal lymph nodes. 4,5 The rationale for intraperitoneal (IP) therapy in ovarian cancer is based on the predominately or solely peritoneal location of ovarian cancer during the early part of the natural history of the disease and the significant pharmacologic advantage of delivering antitumor agents directly into the accessible but confined space of the peritoneal cavity. Three randomized trials in ovarian cancer patients affirmed this assumption by demonstrating improved survival with IP chemotherapy as compared to similar or identical agents delivered systemically.…”

Minimum Distance Matched Sampling With Fine Balance in an Observational Study of Treatment for Ovarian Cancer

“…There were substantial improvements in chemotherapy for ovarian cancer during the period covered by this study, with the introduction of platinum/paclitaxel regimes roughly in 1996 (McGuire et al 1996;Neijt 1996;Harlan, Clegg, and Trimble 2003), and it is of interest whether MOs and GOs differed in the speed with which they adopted the newer drugs. Similarly, the practice of "second-look" surgery (Chu and Rubin 2001) may or may not be effective, and it may possibly be more common among GOs because they are surgeons. When the cancer does recur, MOs and GOs may or may not differ in how aggressively they treat this recurrence of measurable cancer, and the effectiveness of treatment after recurrence is unclear.…”

Treatment of peritoneal carcinomatosis from ovarian cancer. Present, future directions and proposals

“…Nearly 50% of patients with optimal cytoreduction and adjuvant standard treatment in which a 'second-look' surgery is reported as negative develop disease recurrence. This lack of survival advantage for patients enduring 'second-look' laparotomy highlights the need to identify consistently effective consolidation regimens [70].…”