Second-look laparotomy for stage III epithelial ovarian cancer: rationale and current issues.
During the past two decades, the initial treatment of an advanced ovarian malignancy has been generally uniform: it begins with an exploratory laparotomy surgically to remove as much tumor as possible (1) and to stage the cancer (2). For the 70% of patients classified as stages III and IV, surgery is then followed by combination chemotherapy. Although opinions differ as to the optimal regimen, the standard involves a platinum-based program (3), recently also including paclitaxel (4). A second-look laparotomy is often performed in all patients who achieve a clinical complete remission, that is the inability to detect disease by physical examination and non-invasive laboratory tests. This surgical procedure is able to detect clinical disease not apparent on computerized axial tomography (CT scan), ultrasound, magnetic resonance imaging (MRI), serum CA-125 levels or physical examination (5-7). Major questions, however, have arisen around the need for such a procedure, and whether one can justify it in terms of an improved outcome or merely as an assessment of prognosis (8-14). We shall review: (i) the technique; (ii) the rationale; (iii) the results that have been reported from its routine application; and (iv) controversial issues, particularly as they relate to the evolution of therapeutic strategies.
Muderspach
L
L
Department of Gynecology & Obstetrics, University of Southern California-Norris Cancer Center, Los Angeles, 90033, USA.
Muggia
F M
FM
Conti
P S
PS
D004848:Epithelium / Q000473:pathology; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation / Q000379:methods*