A critical reassessment of second‐look laparotomy in epithelial ovarian carcinoma

Eighty‐eight women with epithelial ovarian carcinoma, treated by first‐line chemotherapy, achieved a complete clinical response and underwent second‐look laparotomy to assess the true pathologic status of their disease. Persistent tumor was found in 50 patients (57%). Thirty‐two of these (36%) had obvious gross tumor, whereas, 16 (18%) had microscopic disease. Thirty‐eight patients (43%) had no pathologic evidence of persistent ovarian carcinoma. With a follow‐up of 6 to 60 months, 30 of these patients (79%) remain without evidence of recurrence. Multivariate logistic regression analysis revealed three covariates that were independently significant in predicting continued disease‐free status. These included: the greatest diameter of the largest residual tumor left at the primary operation; histologic features of the tumor; and the diameter of the largest tumor aggregate found at initial operation. A mathematical model based on the most significant covariates was designed to assess the relative risk of any patient having persistent tumor at second‐look laparotomy. A comparison of the predicted to actual outcome revealed a sensitivity of the model of 88%, a specificity of 71%, and an accuracy of 77%. Second‐look laparotomy represents the basis on which potentially curative second‐line salvage therapy can be initiated. With an increasing period of follow‐up and with greater numbers of patients, it can potentially document a complete pathologic response to first‐line therapy administered with curative intent, and identify patients for additional, adjunctive therapy, who are at risk of recurrence.