title: Surgical second-look in epithelial ovarian cancer: high recurrence rate after negative results and lack of survival benefit limits its role in standard management.
abstract: OBJECTIVE
  To evaluate the role of surgical second look (SSL) in epithelial ovarian cancer.
  
  
  METHODS
  One hundred and seventy-one patients clinically free of disease were assessed retrospectively. Ninety-eight (57.3%) patients underwent SSL and 73 (42.7%) were observed. Fifty-one (52.0%) of the SSL operations were negative, 31 (31.6%) microscopically positive, and 16 (16.3%) macroscopically positive. Cytoreduction and/or chemotherapy were administered after positive SSL. Negative SSL and observation group patients were observed without treatment until recurrence was detected. Disease free survival (DFS), overall survival (OS) and clinical characteristics of groups were compared.
  
  
  RESULTS
  While DFS and OS of negative SSL group were better than the observation, microscopic and macroscopic positive SSL groups (p<.01), no significant difference was found between positive SSL and observation groups (p>.05). However, DFS and OS of the microscopic positive SSL group were significantly longer than the macroscopic positive SSL group (p<.01). Thirty-two patients have had recurrences (62.8%) after negative SSL. Only the use of paclitaxel as first-line chemotherapy was seen to prevent recurrence after negative SSL (p<.05). Recurrence after negative SSL was not affected by stage, grade, age, CA-125 level, ascites volume, histologic type or optimal cytoreduction.
  
  
  CONCLUSIONS
  Rate of recurrence after negative SSL remains high, and secondary efforts following positive SSL could not lead to an obvious survival benefit. Therefore, routine use of SSL seems ineffective and unnecessary.
authors.affiliation: Department of Obstetrics and Gynecology, Medical School, Ankara University, Ankara, Turkey.
authors.forename: Salih
authors.initials: S
authors.lastname: Taşkın
authors.affiliation: Department of Obstetrics and Gynecology, Medical School, Ankara University, Ankara, Turkey.
authors.forename: Mete
authors.initials: M
authors.lastname: Güngör
authors.affiliation: Department of Obstetrics and Gynecology, Medical School, Ankara University, Ankara, Turkey.
authors.forename: Elif Aylin
authors.initials: EA
authors.lastname: Taşkın
authors.affiliation: Department of Obstetrics and Gynecology, Medical School, Ankara University, Ankara, Turkey.
authors.forename: Fırat
authors.initials: F
authors.lastname: Ortaç
keywords: Surgical second-look; ovarian cancer; recurrence; survival