This paper reviews the authors experience with “second-look” laparotomy in the management of epithelial ovarian carcinoma, as well as other gynecologic malignancies. Eighty-four second-look laparotomies performed between June, 1972 and March, 1981 were reviewed. Sixty-three patients had epithelial carcinoma of the ovary. The other malignancies represented include nonepithelial cancer of the ovary, cancer of the uterine fundus, and adenocarcinoma of the fallopian tube. All patients were without objective evidence of intraperitoneal disease just prior to the laparotomy. Of the 63 patients with epithelial carcinoma, 22 were Stage I. All patients were treated with Alkeran alone or Alkeran combined with C-Parvum, Megace, or external pelvic radiation. Nineteen of 22, or 86 per cent, of the operations were negative for tumor. In the three positive cases, one patient had disease confined to the pelvis, one had pelvic disease and positive washings, and one had positive washings only. One patient died of disease 2 years later. The other two patients are without evidence of disease after secondary treatment (external pelvic radiation and combination chemotherapy) 6 months to 2 years after the positive laparotomy. Of the 19 negative laparotomies, there were two recurrences. One patient developed a perineal recurrence 9 months after the laparotomy. It was excised and the patient is without evidence of disease 1.5 years later. The second patient developed recurrence 5 years after a negative “second-look.” Ten of 12 Stage II patients were treated with Alkeran alone or in combination with Provera, or external pelvic radiation. One patient was treated with intraperitoneal P32 alone, and another was treated with combination chemotherapy. Nine of 12 laparotomies, or 75 per cent, were negative for malignancy. Two of 12 patients had residual disease after initial tumor-reductive therapy. Both patients with residual disease had positive laparotomies. In the negative laparotomy group, there were no recurrences with 6 months to 5 years follow-up. Sixteen Stage III and IV patients were treated with Alkeran alone or in combination with Megace, C-Parvum, or external pelvic radiation. Ten patients were treated with combination chemotherapy. One patient was treated with Adriamycin alone. Eight of 27 laparotomies, or 27 per cent, were negative for tumor. Five patients were without residual disease after initial tumor-reductive surgery. Of these five, three were in the negative group. In the negative laparotomy group, there were four recurrences or 50 per cent. One of these recurrences occurred in the pleural space and the other three were intraperitoneal. Of the eight patients in the negative laparotomy group, five were treated with Alkeran and three with combination chemotherapy. There were two patients with recurrent ovarian carcinoma treated with chemotherapy followed by “second-look” operations. Both laparotomies were positive. Presence of residual disease after initial tumor reduction is also important in the ratio of negative to positive “second-look” laparotomies. In this study, if residual disease was present, the chance for a negative “second-look” was 19 per cent. If no residual disease was present, the chance was 84 per cent. Residual disease was also important in recurrence after a negative “second-look” laparotomy. If residual disease was present, three out of five, or 60 per cent, developed recurrences. If no residual disease was present, two out of 28, or 7 per cent, recurred. Two “third-look” laparotomies were performed in the epithelial carcinoma subgroup. Both were positive and both patients died 6 months later. The second largest subgroup in the study was composed of patients with germ cell tumors of the ovary. There were nine patients, four with immature teratomas, four with endodermal sinus tumors, and one with a dysgerminoma. All patients had Stage IA disease except the patient with dysgerminoma who was a Stage III. The only positive laparotomy was the patient with dysgerminoma. In the negative group, there have been no recurrences with follow-up ranging from 6 months to 9 years. Rounding out the ovarian cancers were one patient with a Sertoli-Leydig cell tumor and one patient with a carcinosarcoma. Both patients were Stage I and both had negative laparotomies. Both are free of disease, 1 and 4 years after the laparotomy, respectively. There were eight patients with uterine cancer who underwent second-look laparotomies. Six patients had sarcomas (four carcinosarcomas and two leiomyosarcomas). Five of the six patients had intraperitoneal disease initially and five of six had negative second-look operations. Two patients with adenocarcinoma of the uterus
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Jan 1, 1995
Randi R Nordal + 5
Open Access
