A Clinical Significance of Second-look Laparotomy in Patients with Epithelial Ovarian Cancer.
- Author:
Young Joon PARK
1
;
Yoo Seock REE
;
Gyu Rak LEE
;
Young Jae KIM
;
Keon Ho PARK
;
Seong Hee KIM
;
Jin Sil PARK
;
Min Soo PARK
;
Hyun Hee KIM
;
Jeong Kyu HOH
;
Sam Hyun CHO
;
Kyung Tai KIM
Author Information
1. Department of Obstetrics and Gynecology, College of Medicine, Hanyang University.
- Publication Type:Original Article
- Keywords:
Second-look laparotomy;
Complete remission rate;
Survival rate;
Recurrence rate
- MeSH:
Consolidation Chemotherapy;
Drug Therapy;
Gynecology;
Humans;
Laparotomy*;
Logistic Models;
Neoplasm, Residual;
Obstetrics;
Ovarian Neoplasms*;
Pathology;
Recurrence;
Salvage Therapy;
Survival Rate
- From:Korean Journal of Obstetrics and Gynecology
2003;46(9):1693-1701
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
OBJECTIVE: To evaluate pathological complete remission rate (pCR), survival rate, recurrence rate, 91 patients who had clinical complete remission with epithelial ovarian cancer were studied. METHODS: From 1983 to 2002, 91 consecutive patients with epithelial ovarian cancer underwent surgical cytoreduction followed by platinum-based chemotherapy at the Department of Obstetrics and Gynecology, Hanyang University Hospital. At the conclusion of chemotherapy, all patients who were clinically disease free and whose CA 125 was < 35 were offered a second-look operation that obtained over 20 specimens. Of 91 patients who qualified for second-look, 57 underwent the procedure and 34 did not undergo the laparotomy. RESULTS: Among 57 patients who had been performed second-look laparotomy, 40 patients (70%) had negative pathology, 9 (16%) were microscopically positive, and 8 (14%) had gross disease. Patients with positive findings received individualized salvage therapy (14/17). FIGO stage (p<0.01), initial CA 125 level (p=0.07) and residual tumor at primary surgery (p=0.01) correlated with second-look results. Eight (20%: 8/40) of the patients with negative pathology have recurred. Five year survival rate was 95% in patients refusing second look (n=34) was similar to 77% in patients who had been performed second-look operation (n=57). Five-year and ten-year survival rates were 77% and 68% in patients who had performed second-look laparotomy. And 5-year and 10-year survival rates were 84%, 84% in 40 patients with negative pathology, however, 53%, 34% of 17 patients with positive result. Stepwise logistic regression selected two covariates significantly affecting survival: the stage and residual tumor. CONCLUSION: Using the protocol described in a population of optimally resected patients with advanced stage ovarian cancer, second-look laparotomy can impact positively on survival. Patients with residual tumor > 2 cm with advanced stage at primary surgery and negative second-look findings should be the focus of future protocols for consolidation chemotherapy.
