2ND-LOOK LAPAROTOMY IN STAGE-I OVARIAN-CANCER FOLLOWING COMPREHENSIVESURGICAL STAGING

Objective: To evaluate the role of second-look laparotomy in patients with comprehensively staged stage I epithelial ovarian cancer. Methods : We reviewed the medical records and obtained long-term follow-up on 54 stage I patients who had second-look laparotomies following complet e surgical staging and chemotherapy. Results: The distribution by stag e was as follows: stage IA 18 (33%), stage IB two (4%), and stage IC 3 4 (63%). Eighteen patients (33%) had endometrioid tumors, 12 (22%) cle ar cell, 13 (24%) mucinous, eight (15%) serous, and three (6%) undiffe rentiated. Forty-four patients (82%) had grade 2 or 3 tumors. Thirty-e ight (70%) were treated with platinum-based regimens and 16 (30%) rece ived non-platinum regimens. At second-look laparotomy, tumor was ident ified in three women (5.5%). Stage, cell type, and grade did not predi ct the second-look laparotomy result, although no patient with a grade 1 tumor had a positive second-look laparotomy. With a mean follow-up of 48 months from second-look laparotomy, 11 women (22%) have had recu rrences following negative second looks. Tumor grade was a strong pred ictor of recurrence following negative second-look laparotomy (P < .00 01), with the risk of recurrence being 0% for grades 1 and 2 and 52% f or grade 3. Substage, cell type, and chemotherapy type and duration di d not predict recurrence. Conclusions: The likelihood of a positive se cond-look laparotomy is about 5% in well-staged stage I ovarian cancer . Patients with stage I, grade 3 tumors have a risk of recurrence of a pproximately 50% following negative second-look laparotomy.