Second look for ovarian cancer: Laparoscopy or laparotomy? A prospective comparative study

Objective. The objective of this study was to evaluate, for patients with o varian cancer, the feasibility, reliability, and complications of a laparos copic second look and to compare them with those of a second look by laparo tomy. Methods, Twenty patients treated by initial surgery and adjuvant chemothera py for ovarian carcinoma underwent a laparoscopic second look, immediately followed by a comparative laparotomy. All were in complete remission after chemotherapy, Both operations were performed according to a predefined chec klist, identical for both surgical techniques and for each patient: after l iberation of adhesions, an exhaustive intraperitoneal inspection was perfor med, with systematic peritoneal cytology and biopsies, Each patient therefo re was her own control for the two techniques. Results. The positive predictive value of laparoscopy for the diagnosis of residual disease was 100% (6 of 6 cases), while the negative predictive val ue was 86% (2 false-negative cases out of 14). Because of the presence of p ostoperative adhesions, the rate of complete intraperitoneal investigation was 95% for laparotomy versus 41% for laparoscopy. The complication rate of laparoscopy requiring laparotomy was 5.3%. Conclusions. After treatment of ovarian cancer, a laparoscopic second look appears to be less reliable than one performed by laparotomy. The presence of severe postoperative adhesions is the main obstacle to an exhaustive, re liable, and safe laparoscopic second look. (C) 1999 Academic Press.