Related Experiment Videos
Second-look and second surgery: second chance or second best?
1Department of Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands. E.Sijmons@azu.nl
Seminars in Surgical Oncology
|July 7, 2000
Summary
Second-look laparotomy (SLL) in ovarian cancer does not definitively improve survival and should be reserved for research. The value of secondary surgery depends on tumor chemo-sensitivity.
Area of Science:
- Gynecologic Oncology
- Surgical Oncology
- Clinical Research
Background:
- Second-look laparotomy (SLL) was introduced 40 years ago for ovarian cancer patients achieving clinical complete remission.
- Its impact on disease-free and overall survival remains debated.
- Key technical aspects and the necessity of SLL are not fully clarified.
Purpose of the Study:
- To evaluate the survival benefit of second-look laparotomy (SLL) in ovarian cancer.
- To discuss the unresolved technical and strategic issues surrounding SLL.
- To determine the role of secondary surgery in recurrent ovarian cancer.
Main Methods:
- Literature review and critical analysis of existing studies on SLL in ovarian cancer.
- Discussion of surgical parameters: biopsy quantity, laparoscopy vs. laparotomy, and lymphadenectomy.
- Evaluation of secondary cytoreduction strategies based on tumor response.
Main Results:
- Tumor is found in over 50% of advanced ovarian cancer patients at SLL despite clinical remission.
- A negative SLL (no visible tumor) still has a 35% recurrence rate.
- Secondary surgery for recurrent disease improves survival if the tumor remains chemo-sensitive.
Conclusions:
- Currently, SLL should only be performed in a research setting due to lack of survival evidence.
- The effectiveness of secondary surgery hinges on the chemo-sensitivity of recurrent ovarian cancer.
- Complete secondary cytoreduction followed by chemotherapy improves survival in patients with long-term remission.