2ND-LOOK SURGERY IN THE MANAGEMENT OF EPITHELIAL OVARIAN-CARCINOMA

The constructs for incorporating second-look surgery (SLL) in the trea tment schema for ovarian epithelial carcinoma are being challenged. Al though second-look surgery remains the hallmark for assessing disease status at the completion of adjuvant chemotherapy, its continued utili ty must demonstrate potential benefits in both the presence and absenc e of disease. While critics cite as unacceptable the recurrence rates (20-50%) after negative SLL, the patients so identified have demonstra ted chemosensitivity and harbor optimal tumor volumes if present and p ossibly more biologically favorable tumors. These very characteristics should render negative SLL patients ideal candidates for consolidatio n therapy. Furthermore, age, histologic grade, and residual volume str atifies patients into high- and low-risk categories for recurrence aft er negative second look and should further facilitate consolidation th erapy selection. Similarly, longevity following positive SLL is correl ated adversely to advancing age and the histologic grade and the resid uum of the tumor identified at reexploration. Recognizing that age and grade are predetermined factors, aggressive secondary cytoreduction h as the potential of extending longevity. The latter is supported by ma thematical tumor kinetic models and several focused, large, single-ins titution retrospective analyses. Therefore, the value of SLL is appare nt but the criteria for its continued utilization in advanced ovarian cancer should include its performance by appropriately trained surgeon s and the availability of (and preferably prospective trials for) both consolidation and salvage therapy to which all patients would optimal ly be afforded access. (C) 1994 Academic Press, Inc.