Value of tumor-reductive secondary operation (interventional laparotomy) in ovarian cancer

Abstract

Only 20-50% of patients with advanced ovarian cancer have minimal residual disease after aggressive primary cytoreductive surgery. For patients with residual tumour, responding to platinum-based chemotherapy, new therapeutic procedures should be attempted. In most cases, the benefit of performing secondary surgery could not be clearly demonstrated. But there is a consensus of opinion that a second-look procedure in order to confirm complete remission does not improve survival. Between January 1984 and July 1990, 346 patients with primary ovarian cancer were treated at our institution. 190 patients underwent secondary surgery, 93 of these had secondary debulking and are part of the study. After secondary cytoreductive surgery 38 patients (41%) had no residual disease, 35 patients (38%) had disease less than 2 cm, and 20 patients (21%) had disease greater than 2 cm. Mean survival in patients with no residual disease after secondary debulking surgery was 46 months and significantly longer as in patients with residual disease. Patients with residual tumour at primary surgery and no secondary cytoreductive operation survived 35 months, with a significant difference to the patients with secondary debulking and no residual disease. Secondary debulking surgery should be performed in all patients in whom minimal residual disease can be achieved. Preoperative diagnostic tools, including CA 125 value, computed tomography and immunoscintigraphy, should predict a tumour-free situation after secondary cytoreductive surgery.