A Clinical Significance of Second-look Laparotomy in Patients with Epithelial Ovarian Cancer

Park, Young Joon; Ree, Yoo Seock; Lee, Gyu Rak; Kim, Young Jae; Park, Keon Ho; Kim, Seong Hee; Park, Jin Sil; Park, Min Soo; Kim, Hyun Hee; Hoh, Jeong Kyu; Cho, Sam Hyun; Kim, Kyung Tai

Abstract

OBJECTIVE
To evaluate pathological complete remission rate (pCR), survival rate, recurrence rate, 91 patients who had clinical complete remission with epithelial ovarian cancer were studied.
METHODS
From 1983 to 2002, 91 consecutive patients with epithelial ovarian cancer underwent surgical cytoreduction followed by platinum-based chemotherapy at the Department of Obstetrics and Gynecology, Hanyang University Hospital. At the conclusion of chemotherapy, all patients who were clinically disease free and whose CA 125 was < 35 were offered a second-look operation that obtained over 20 specimens. Of 91 patients who qualified for second-look, 57 underwent the procedure and 34 did not undergo the laparotomy.
RESULTS
Among 57 patients who had been performed second-look laparotomy, 40 patients (70%) had negative pathology, 9 (16%) were microscopically positive, and 8 (14%) had gross disease. Patients with positive findings received individualized salvage therapy (14/17). FIGO stage (p<0.01), initial CA 125 level (p=0.07) and residual tumor at primary surgery (p=0.01) correlated with second-look results. Eight (20%: 8/40) of the patients with negative pathology have recurred. Five year survival rate was 95% in patients refusing second look (n=34) was similar to 77% in patients who had been performed second-look operation (n=57). Five-year and ten-year survival rates were 77% and 68% in patients who had performed second-look laparotomy. And 5-year and 10-year survival rates were 84%, 84% in 40 patients with negative pathology, however, 53%, 34% of 17 patients with positive result. Stepwise logistic regression selected two covariates significantly affecting survival: the stage and residual tumor.
CONCLUSION
Using the protocol described in a population of optimally resected patients with advanced stage ovarian cancer, second-look laparotomy can impact positively on survival. Patients with residual tumor > 2 cm with advanced stage at primary surgery and negative second-look findings should be the focus of future protocols for consolidation chemotherapy.