What is the role of second-look laparotomy in the treatment of ovarian cancer?

Updated: Aug 10, 2020
  • Author: Andrew E Green, MD; Chief Editor: Yukio Sonoda, MD  more...
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Answer

Second-look laparotomy is a surgical procedure performed within a few weeks following initial treatment of epithelial ovarian cancer when no disease is evident on clinical examination, by CA125, or radiology. The aim is to inspect the abdominal cavity for disease and, when no macroscopic disease is found, perform peritoneal washings and extensive biopsies for pathologic assessment for microscopic disease.

Some years ago this surgery went out of fashion in many centers because no effective treatment was available for patients found to have disease after front-line therapy, and, thus, the evaluation did not improve prognosis. Of those patients who had completely negative findings at second-look surgery (a complete pathologic response), 56% had recurrence by 5 years and 60% by 10 years. In the Gynecologic Oncology Group Study #172, despite the improvement in overall survival rate, 65% of these patients developed recurrence during the study. [73]

Efforts are now under way to find effective methods of delaying or preventing recurrence following front-line therapy. The best way to determine that a woman is pathologically disease-free is a second surgery, because regular clinical investigations are far from accurate. In many instances it may be possible to perform this evaluation adequately using the laparoscope.


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