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Second-Look Laparotomy in Stage III Epithelial Ovarian Cancer

Clinical Variables Associated With Disease Status

Division of Gynecologic Oncology, Department of Pathology, UCLA School of Medicine, Center for Ovarian Cancer, Jonsson Comprehensive Cancer Center, Los Angeles, California.

Variables associated with a negative second-look laparotomy in patients with stage III epithelial ovarian carcinoma are analyzed. Fifty-six patients were clinically free of disease after systemic chemotherapy and were subjected to second-look laparotomy to assess tumor status. Eighteen of these patients (32.1%) had no evidence of malignancy. Eight (14.3%) additional patients with no gross evidence of disease at laparotomy had microscopic persistence; five of these had disease documented in the pelvic or para-aortic lymph nodes. Significant Variables associated with a histologically and cytologically negative second-look operation were low tumor grade (P < .01), the use of cis-platinum containing combination chemotherapy (P < .01), patient age less than or equal to 50 years (P < .02), small residual tumor (less than 0.5 cm) before chemotherapy (P < .05), and metastatic tumor less than or equal to 10 cm before initial cytoreduction (P < .05). patients treated with six to nine cycles of combination chemotherapy had the same probability of a negative second-look laparotomy as those treated with ten to 12 cycles. Multivariate discriminate analysis indicated that patients with low tumor grade, those receiving cis-platinum containing combination chemotherapy, and those with minimal residual tumors (less than 0.5 cm) after primary cytoreductive surgery correctly classify second-look status in 78.6% of patients. Until a nonsurgical method of monitoring subclinical disease is available, a thorough second-look laparotomy, including a pelvic and para-aortic lymphadenectomy, should be performed.

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