WHAT IS THE ROLE OF REASSESSMENT LAPAROSCOPY IN THE MANAGEMENT OF GYNECOLOGIC CANCERS IN 1995

One hundred fifty-four patients with a diagnosis of ovarian, primary p eritoneal, or fallopian tube carcinoma underwent 181 reassessment proc edures to detect persistent or recurrent disease between January 1, 19 89 and December 31, 1994 at Cedars-Sinai Medical Center. One hundred f our laparoscopic procedures were performed. Eleven of these procedures were converted to laparotomy due to severe adhesions. Therefore, a to tal of 88 reassessment laparotomies were performed during the study pe riod. Fifty-seven of 93 laparoscopies and 69 of 88 laparotomies were d one as second-look procedures. There was no significant difference bet ween the two groups with respect to patient age, tumor histology, degr ee of primary cytoreduction, and tumor stage or grade. Significant dif ferences were found between laparoscopy and laparotomy groups in the f ollowing outcome variables evaluated: estimated blood loss (33.9 mi vs 164.9 mi, P = 0.0001), operative time (81.3 min vs 130.4 min, P = 0.0 001), days of hospitalization (0.3 days vs 6.8 days, P = 0.0001), and direct cost/case ($2765 vs $5420, P = 0.0001). Despite obtaining 50% f ewer biopsies with laparoscopy than laparotomy, the ability to detect disease was similar between these two groups: 47.3% vs 55.7% for all p rocedures and 52.6% vs 53.6% in the patients undergoing second-look pr ocedures. Major complications in the laparoscopy group included transv erse colon perforation (1), small bowel perforation (2), enterocutaneo us fistula (1), and a retroperitoneal hematoma (1). Major complication s in the laparotomy group included cystotomy (1), left ureteral injury (1), enterotomy (2), and SBO (4). Laparoscopy, when technically feasi ble, appears equally as effective as laparotomy in detecting persisten t or recurrent malignant disease with less blood loss, less days spent in the hospital, less financial burden, and no increase in patient mo rbidity. (C) 1996 Academic Press, Inc.