Evaluation of second-look laparotomy for ovarian cancer: second-look vs. serum CA125

Thirty patients with ovarian cancers underwent second-look operations in our hospital between 1981 and 1989, and the results were compared with serum CA125 values. The over-all positive rate determined by second-look laparotomy in the present series was 56.7% (17/30)-40% as gross and 17% an microscopic tumors. The result of the second-look was related to the staging and size of the residual tumor after the previous operation: 1/3 of stage I and II lesions and 16/27 of stage III and recurrent lesions were positive on second-look. The positive rates of those patients who were free from residual tumor and those with residual tumors less than or equal to 2 cm or greater than 2 cm were 28.6% (2/7), 60% (9/15) and 75% (6/8), respectively. Among the 23 patients assayed as to serum CA125 level before the second-look, 18 (78%) were within normal limits (less than 65 U/ml), including 12 patients (66.6%) who were second-look positive and 6 who were negative. Five patients with microscopic tumors and 3 patients with gross tumors less than or equal to 2 cm all had normal CA125 levels before the second-look. Among the 5 of 9 patients with gross tumors greater than 2 cm who had elevated CA125 levels, not one was found to be negative on second-look. This may imply that the elevated CA125 levels indicate recurrence, though a normal CA125 assay certainly does not preclude recurrence.