The role of laparoscopy in second-look evaluations for ovarian cancer

Background. The aim of this study was to evaluate the accuracy and safety o f laparoscopic second-look operations in patients with ovarian cancer. Methods. We retrospectively reviewed the medical records of all patients wh o have undergone laparoscopic second-look procedures for ovarian cancer at our institution. Results. From July 1993 to December 1998, 150 patients underwent laparoscop ic second-look operations. The mean age of patients was 53 years (range, 25 -78 years). The majority of patients (87%) had Stage III or IV disease at i nitial surgery; the remainder were Stage IT or unstaged. Eighty-two patient s (54%) had had optimal cytoreduction at the time of their initial surgery. All patients had completed primary chemotherapy and were clinically diseas e-free based on imaging studies and CA-125 levels at the time of second loo k. Sixty-nine patients (46%) were found to have pathologically negative sec ond looks; thus, the rate of positive second-look evaluations was 54%. The rate of conversion to laparotomy was 18/150 (12%), In 3 cases this was seco ndary to bowel injury; one patient sustained a bladder injury; the remainde r of conversions to laparotomy were for secondary cytoreduction. There was only 1 case where the patient was found to have extensive adhesions and lap aroscopy was abandoned. The overall rate of major complications was 2.7%. Conclusions. In our experience, laparoscopy is a safe and accurate method o f second-look assessment in patients with ovarian cancer. The incidence of complications is low, particularly in this group of patients, all of whom h ave undergone prior abdominal surgery. The rate of negative evaluations and the rate of recurrences in patients with negative second looks are equival ent to those described in studies of second-look assessment by laparotomy. (C) 2001 Academic Press.