Second-look laparotomy in advanced ovarian cancer: A critical assessment of morbidity and impact on survival

Background: The routine inclusion of second-look laparotomy in the management of patients with epithelial ovarian cancer is controversial. At issue is the justification of morbidity incumbent upon surgery and the possible survival benefit of secondary cytoreduction. Methods: The rate of major complications of surgery was assessed among 100 consecutive patients with FIGO stage III or IV epithelial ovarian cancer who underwent second-look laparotomy. All patients demonstrated a complete clinical and biochemical (CA125 <35 U/ml) response to first-line therapy. Patients were stratified based on findings at surgery. Patients in group 1 (n = 37) had a negative second-look laparotomy. Patients in group 2 (n = 35) had only microscopically appreciable disease. Patients in group 3 (n = 28) had macroscopic disease. Cytoreductive efforts aimed at resection of all macroscopic disease were carried out for patients in group 3. Results: Thirteen patients (13%) had 15 major complications at surgery. Comparison of the complication rates for patients in groups 1,2, and 3, of 10%, 8.5%, and 21.4%, respectively, did not achieve statistical significance (p = 0.228). The estimated 5-year survival for patients in groups 1, 2, and 3 of 63.9%, 39.8%, and 14.2%, did differ significantly (p < 0.0001). Cytoreductive efforts resulted in the resection of all macroscopic disease in 18 of 28 patients (64.2%) in group 3. The median survival for this group of 18 patients was 33 months, and estimated 5-year survival was 20%. These values do not differ significantly from those observed for patients in group 2. Conclusion: The major complication rate associated with second-look laparotomy is not prohibitive Secondary cytoreductive efforts may result in improved survival for patients with epithelial ovarian cancer.