Second-Look Operation for Epithelial Ovarian Cancer: Laparoscopy or Laparotomy?

Abu‐Rustum, Nadeem R.; Barakat, Richard R.; Siegel, Patricia; Venkatraman, Ennapadam; Curtin, John P.; Hoskins, William J.

doi:10.1016/0029-7844(96)00265-7

Cited by 63 publications

(22 citation statements)

References 12 publications

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“…Furthermore, there are reported technical difficulties with the laparoscopic procedure, particularly when intra abdominal adhesions are present in advanced stage disease [23][24][25][26]. More importantly, there is a lack of tactile sensation which is of great importance in assessment of resectability and achievement of OCR [27][28][29]. We believe such shortcomings can be avoided by using a simple minilaparotomy as described in this paper.…”

Section: Discussionmentioning

confidence: 89%

Mini-laparotomy in advanced ovarian cancer

et al. 2011

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Optimal cytoreduction (OCR) remains the gold standard treatment of ovarian cancer. Current radiological imaging has limited sensitivity and specificity in prediction of achieving OCR prior to surgery. This prospective pilot study included 50 patients with advanced ovarian carcinoma. Prior to the main laparotomy, a mini-laparotomy-just large enough to allow a hand in-was performed. A decision was then made as to whether achieving OCR is "possible", "not possible" or lastly "unsure". Formal laparotomy then followed. At the end of the formal laparotomy, cytoreduction was regarded as either "optimal" or "suboptimal" based on residual disease. Out of 45 cases where results were deemed suitable for analysis, 27 were regarded as "OCR possible", out of which OCR was achieved in 24 cases following full laparotomy. Ten were commented upon as "unsure" and only in three cases OCR was feasible. Eight were classed as "OCR not possible" and in none of these OCR was obtained. The only noted complication associated with minilaparotomy was bleeding in just three cases (6%). The sensitivity, specificity, PPV and NPV of mini-laparotomy were 100%, 73%, 89% and 100%, respectively. However, when "unsure", only in 30% OCR was achieved. We concluded that mini-laparotomy is a safe, simple and effective technique for predicting feasibility of OCR. This simple technique could obviate the need for full laparotomy in patients who may benefit from neo-adjuvant chemotherapy.

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Section: Discussionmentioning

confidence: 89%

Mini-laparotomy in advanced ovarian cancer

et al. 2011

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“…The initial study of second-look laparoscopy reported inadequate visualization, a high false-negative rate of 11% to 55%, a high rate of complications involving primarily bowel injuries (2-9%), and a higher recurrence rate after negative second-look laparoscopy [15][16][17][18][19]. More recent studies, however, have shown that laparoscopic second-look evaluations are equivalent to those performed by laparotomy but associated with significantly lower blood loss, decreased surgical duration, fewer days of hospitalization, and lower hospital charges [21,22].…”

Section: Discussionmentioning

confidence: 97%

Feasibility and accuracy of second-look laparoscopy after gastrectomy for gastric cancer

et al. 2009

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“…The term "second-look surgery" refers to a systematic surgical exploration performed in patients with advanced ovarian cancer who have completed a planned course of chemotherapy and are in a complete clinical remission. The surgery can be performed via laparotomy or laparoscopy with equivalent efficacy [7]. In patients with no gross evidence of tumor, multiple biopsies are obtained from the same locations as a primary staging procedure.…”

Section: Opinion Statementmentioning

confidence: 99%

Advanced ovarian cancer

Dennis

Sabbatini

2000

Curr. Treat. Options in Oncol.

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State-of-the-art treatment for advanced ovarian cancer requires a multimodality approach. Aggressive surgical debulking with the goal of optimal cytoreduction is the initial step. After primary cytoreductive surgery, standard treatment for patients with stage III and IV disease is systemic combination chemotherapy consisting of six cycles of paclitaxel and carboplatin. Approximately 70% of patients enter a clinical remission with this approach, yet less than 30% remain disease free. Options following primary therapy include observation or second surgical assessment if no clinical evidence of disease is present. Novel strategies for consolidation are needed. Second-look surgery can be performed safely and effectively laparoscopically, and this is the most accurate means of identifying patients who appear to be clinically free of disease but actually harbor persistent cancer. Although this procedure is an extremely accurate means of identifying these patients, women who have pathologically negative second-look surgery are still at risk for relapse. Patients can receive additional treatment following second-look surgical assessment via the intraperitoneal route if they are pathologically negative or if they have microscopic or small volume disease. Alternatively, additional systemic chemotherapy can be given with non-cross-resistant systemic agents, but no current standard approach for consolidation therapy exists for patients following the completion of primary treatment. Unfortunately, most patients relapse. Multiple agents with similar activity in phase II trials are available to treat patients with advanced recurrent disease. Combination therapy in this setting has not been shown to have significantly superior progression-free or overall survival compared with single agents. The selection of treatment for patients with recurrent disease is currently based on a determination of the treatment-free interval since last treatment, as well as the route, schedule, and expected side effects of the agent.

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Second-Look Operation for Epithelial Ovarian Cancer: Laparoscopy or Laparotomy?

Cited by 63 publications

References 12 publications

Mini-laparotomy in advanced ovarian cancer

Mini-laparotomy in advanced ovarian cancer

Feasibility and accuracy of second-look laparoscopy after gastrectomy for gastric cancer

Advanced ovarian cancer

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