2ND-LOOK LAPAROTOMY FOR STAGE-III EPITHELIAL OVARIAN-CANCER - RATIONALE AND CURRENT ISSUES

During the past two decades, the initial treatment of an advanced ovar ian malignancy has been generally uniform: it begins with an explorato ry laparotomy surgically to remove as much tumor as possible (1) and t o stage the cancer (2). For the 70% of patients classified as stages I II and IV, surgery is then followed by combination chemotherapy. Altho ugh opinions differ as to the optimal regimen, the standard involves a platinum-based program (3), recently also including paclitaxel (4). A second-look laparotomy is often performed in all patients who achieve a clinical complete remission, that is the inability to detect diseas e by physical examination and non-invasive laboratory tests. This surg ical procedure is able to detect clinical disease not apparent on comp uterized axial tomography (CT scan), ultrasound, magnetic resonance im aging (MRI), serum CA-125 levels or physical examination (5-7). Major questions, however, have arisen around the need for such a procedure, and whether one can justify it in terms of an improved outcome or mere ly as an assessment of prognosis (8-14). We shall review: (i) the tech nique; (ii) the rationale; (iii) the results that have been reported f rom its routine application; and (iv) controversial issues, particular ly as they relate to the evolution of therapeutic strategies.