2ND-LOOK LAPAROTOMY IN STAGE-III EPITHELIAL OVARIAN-CANCER - CLINICAL-VARIABLES ASSOCIATED WITH DISEASE STATUS

Abstract

Variables associated with a negative 2nd-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 2nd-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; 5 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 < 0.01), the use of cis-platinum containing combination chemotherapy (P < 0.01), patient age .ltoreq. 50 yr (P < 0.02), small residual tumor (< 0.5 cm) before chemotherapy (P < 0.05), and metastatic tumor .ltoreq. 10 cm before initial cytoreduction (P < 0.05). Patients treated with 6-9 cycles of combination chemotherapy had the same probability of a negative 2nd-look laparotomy as those treated with 10-12 cycles. Multivariate discriminate analysis indicated that patients with low tumor grade, those receiving cis-platinum containing combination chemotherapy, and those with minimal residual tumors (< 0.5 cm) after primary cytoreductive surgery correctly classify 2nd-look status in 78.6% of patients. Until a nonsurgical method of monitoring subclinical disease is available, a thorough 2nd-look laparotomy, including a pelvic and para-aortic lymphadenectomy, should be performed.