Second-look laparotomy in advanced ovarian cancer: A critical assessment of morbidity and impact on survival

Hempling, Ronald E.; Wesolowski, Judy A.; Piver, M. Steven

doi:10.1007/bf02303586

Cited by 22 publications

(13 citation statements)

References 20 publications

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“…Several studies indicate that the patients most likely to benefit from debulking are those whose disease is amenable to removal of all gross tumor. In these cases, subsequent survival has shown improvement for the patients able to achieve reduction to microscopic disease [9,22,25,26]. Given the inherent complications of extensive surgery and the lack of documented improvement in survival for those with disease precluding maximal debulking, resection should only be performed if all persistent disease can be removed.…”

Section: Treatment For Positive Sllmentioning

confidence: 96%

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Second-look laparotomy for epithelial ovarian cancer: A reappraisal

Chu

Rubin

2001

Curr Oncol Rep

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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.

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Section: Treatment For Positive Sllmentioning

confidence: 96%

“…The procedure should be limited to those patients for whom surgical findings will determine subsequent therapy [8]. In the setting of proper stage I disease treated with induction chemotherapy, SLL should not be performed because the likelihood of positive findings is low [9].…”

Section: Definitionmentioning

confidence: 99%

Second-look laparotomy for epithelial ovarian cancer: A reappraisal

Chu

Rubin

2001

Curr Oncol Rep

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“…Multivariate analyses have shown that almost without exception early-stage disease can be used as an independent factor in predicting a negative second look. There was no effect from the second- [18] 100 III, IV 37 (37) n CRR, number of patients with clinical complete remission; neg. SLL, no tumour found at second-look laparotomy (neither microscopically nor macroscopically).…”

Section: Evaluation Of Primary Treatment At Second-look Laparotomymentioning

confidence: 98%

“…This is why the reported complication rate has such a wide range (11% to 67%). Hempling et al [18] reported major complications such as intra-operative haemorrhage, alteration of planned surgical procedure, unplanned admission to intensive care, hospital re-admission within 30 days, and mortality. In 35 patients with microscopic disease, the complication rate was 8.5%.…”

Section: Complications Of Second-look Surgerymentioning

confidence: 99%

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

Sijmons

Heintz

2000

Semin. Surg. Oncol.

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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.

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“…This morbidity has been well evaluated in malignant disease; however, the morbidity rate after secondary surgery would theoretically have been reduced in LMPOT, which requires less radical surgery. 20 In the present study, morbidity was not studied because several patients had undergone this procedure outside our institution and precise details concerning morbidity were not available in all cases. In our institution, we use a laparoscopic approach to reduce such morbidity when performing secondary surgery in this context.…”

Section: Limits Of This Surgerymentioning

confidence: 99%