title: ACOG Committee opinion. Second-look laparotomy for epithelial ovarian cancer. Number 165, December 1995 (replaces no. 100, November 1991). Committee on Gynecologic Practice. American College of Obstetricians and Gynecologists.
abstract: The Committee on Gynecologic Practice makes the following recommendations: Second-look laparotomy is the most accurate method of assessing disease status in a patient who has completed initial therapy for ovarian cancer and who is clinically free of disease. It serves as a useful early endpoint in assessing the effectiveness of treatments in prospective randomized clinical trials. There are, however, no prospective clinical trials that demonstrate an advantage in survival for patients who have undergone second-look laparotomy. A negative second-look laparotomy is associated with improved survival rates and may be used to justify either discontinuing therapy altogether or using an investigational consolidation therapy. In patients with stage I or II ovarian cancer who have had complete surgical staging and appropriate adjuvant therapy and who are asymptomatic, a second-look laparotomy is rarely positive (5%) and is not thought to be of value. Retrospective studies suggest that maximal cytoreduction (to nodules < 5 mm) of tumors in patients with stage III or IV ovarian cancer who are clinically free of disease prior to secondlook laparotomy is associated with improved median survival rates despite the lack of evidence that current second-line therapies are effective. Second-look laparotomy usually should be performed by a gynecologic oncologist who has a complete understanding of ovarian cancer and has defined the goals of second-look laparotomy for an individual patient. The surgeon must have the surgical skills to perform a complete operation as described in the "Assessment" section. Second-look laparotomy is not considered a "standard" or "mandatory" operation for all women with ovarian cancer. The additional morbidity and cost of the procedure must be weighed against the expected benefit for the individual patient. A second-look laparotomy may be appropriate based on the goals of treatment for an individual patient or as part of a clinical protocol.
mesh_terms: D002277:Carcinoma / Q000601:surgery*; D005260:Female; D006801:Humans; D007813:Laparotomy; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000601:surgery; D010051:Ovarian Neoplasms / Q000601:surgery*; D012086:Reoperation