| November 2004 · Vol. 16, No. 11 SURGICAL TECHNIQUES
Ovarian cancer: What can we expect of second-look laparotomy?
It is the only way to confirm a complete pathologic response to therapy and individualize the prognosis.
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Fast Track
SLL detects residual disease in 30% to 50% of patients.
Median survival after negative findings can exceed 140 months.
Attempt debulking only if persistent disease is deemed totally resectable.
Laparoscopic second look has a false-negative rate of at least 14%.
Check www.obgmanagement.com for extensive data from studies of salvage regimens and consolidation therapies.
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Christina
S.
Chu,
MDAssistant Professor, Division of Gynecologic Oncology,
Department of Ob/Gyn, University of Pennsylvania Medical Center,
Philadelphia Stephen
C.
Rubin,
MDProfessor and Chief, Division of Gynecologic Oncology,
Department of Ob/Gyn, University of Pennsylvania Medical Center,
Philadelphia
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KEY POINTS
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Second-look laparotomy (SLL) is the only way to confirm complete pathologic response to ovarian cancer therapy.
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Offer SLL only to patients for whom results will affect decision-making—and only after discussion with the patient and a gynecologic oncologist.
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Although negative SLL findings confer improved prognosis, disease recurs in up to 60% of patients.
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Candidates should be in clinical remission as determined by physical examination, abdominopelvic imaging, and serum CA-125 determination.
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The disturbing fact that epithelial ovarian cancer often recurs after clinical remission poses this challenge: How do we identify the women with subclinical disease who may benefit from additional consolidation therapy?
Given the inability of noninvasive studies such as computed tomography, magnetic resonance imaging, and positron emission tomography to reliably detect small-volume and microscopic disease, second-look laparotomy (SLL) is the only technique capable of confirming a complete pathologic response to therapy.
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