HOW DOES NEGATIVE CLINICAL-EVALUATION OF OVARIAN-CARCINOMA AFTER FULLCOURSE OF CHEMOTHERAPY CORRELATE WITH 2ND-LOOK LAPAROTOMY FINDINGS

Surgical reexploration was performed in 46 patients with epithelial no nmucinous ovarian adenocarcinoma requiring adjuvant chemotherapy whose initial therapy consisted of optimum debulking and surgical staging. All patients were placed on CAP (cisplatinum, Adriamycin, cyclophospha mide) chemotherapy for at least six courses until proved to be clinica lly disease free (mainly CA-125 below 35 U/ml and normal ultrasonograp hy or computerized tomography). All women underwent second-look laparo tomy (SLL) after completion of adjuvant therapy. We classified SLL fin dings in five categories, namely, no evidence of disease, cytological evidence of disease, histological evidence of disease, macroscopic evi dence of disease (<2 cm), and bulky tumor (>2 cm). SLL demonstrated 14 (30%) patients with disease. Of these, five cases had histological ev idence of disease and nine had macroscopic disease; however, we found no patient with persistent disease larger than 1.5 cm. No patient in s tage I demonstrated disease at SLL. All cases with macroscopic disease and three cases with histological disease were initially in stage III . We found that about one third of cases who were clinically free of d isease had persistent disease at the completion of chemotherapy. Hence , we conclude that routine SLL is still of importance in the managemen t of patients with epithelial ovarian adenocarcinoma except those with stage I disease. (C) 1994 Wiley-Liss, Inc.