The second-look operation improves survival in suboptimally debulked stage III ovarian cancer patients.
In a single-institution retrospective cohort study, 230 patients were treated for stage III primary ovarian cancer and 175 became eligible for second-look operations by virtue of a complete clinical response after primary surgical cytoreduction and platinum-based combination chemotherapy. Of these, 109 underwent a second-look operation. Optimal primary cytoreduction was defined as residual disease < or =1 cm. Median follow-up was 68.3 months. Five-year survival for all the 230 stage III ovarian cancers was 43.4%. Among all eligible patients (n = 175), there was no survival difference (P = 0.67) in those having second look (57.3%, 5-year survival) versus no second look (48.7%). In those patients with optimal primary cytoreduction (n = 118), there was no survival advantage to second look (69% versus 61%, P = 0.7). However, in those with suboptimal primary cytoreduction (n = 47), 5-year survival was 36% in those having second look versus only 13% in those refusing second look (P < 0.05). Multivariate analysis identified second-look surgery as the only significant independent prognostic variable affecting survival (RR = 0.321, P < 0.04). Patients with suboptimal debulking at primary surgery for stage III ovarian cancer appear to achieve a survival benefit from second-look surgical procedures, presumably from the early identification and treatment of residual disease.
Rahaman
J
J
Division of Gynecologic Oncology, The Mount Sinai Medical Center, 1176 Fifth Avenue, Box 1173, New York, NY 10029, USA. jamal.rahaman@mssm.edu
Dottino
P
P
Jennings
T S
TS
Holland
J
J
Cohen
C J
CJ
D000970:Antineoplastic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017671:Platinum Compounds / Q000627:therapeutic use; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis
D000970:Antineoplastic Agents; D017671:Platinum Compounds