[Is there a place for 2nd look laparotomy in the treatment of ovarian cancers?].
The charts of 147 patients with advanced ovarian cancers responding completely (CR) or partially (PR > 50%) to a primary cisplatin-based chemotherapy are reviewed. All fulfilled our criterias to undergo second-look laparotomy. One hundred patients (group A) underwent second-look laparotomy and 47 patients (group B) other features of control: laparoscopy 37 patients, clinical control ten patients. Apart metastatic spread more frequent in group B (A vs B = 10 vs 32%) and tumor grade 1 more frequent in group B (A vs B = 33 vs 49%), the two groups were well balanced concerning tumor characteristics and treatment features. All patients had received a complementary treatment after the second-look procedures. With a median follow-up of 86 months in group A and 104 months in group B, no difference was found in overall nor in recurrence-free survival. Within group A, 34 patients had achieved pathologic proved complete remission. Their 5-year survival was 73% with an incidence of recurrence of 32%. Second-look laparotomy was found an invasive technique with a 15% operative morbidity. Its therapeutic apport seems absent and the diagnostic role limited to indication of radiotherapy in CR patients. Second-look laparotomies should be reserved to trials evaluating its proper place but should not be used systematically to assess tumor response to chemotherapy. The good 5-year survival of the CR mi group suggest the beneficial impact of complementary treatment, but prospective trials are needed to evaluate the place of this treatment.
Stöckle
E
E
Service de chirurgie, fondation Bergonié, Bordeaux, France.
Bussières
E
E
Stöckle
M
M
Avril
A
A
Thomas
L
L
Chauvergne
J
J
Brunet
R
R
Pigneux
J
J
Marée
D
D
D000328:Adult; D000368:Aged; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D012074:Remission Induction; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate
D002945:Cisplatin
Que reste-t-il de la laparotomie de deuxième vue dans le traitement des cancers de l'ovaire?