Long-term follow-up of women with ovarian cancer after positive second-look laparotomy

Gynecol Oncol. 2003 Dec;91(3):563-8. doi: 10.1016/j.ygyno.2003.08.036.


Objective: Previous reports indicate that cytoreduction and salvage therapy with P32 or whole abdominal radiation may improve survival in patients with positive findings at second-look laparotomy (SLL). The aim of this investigation was to determine whether these findings held true with extended follow-up and a larger patient cohort.

Methods: From 1977 (the year platinum-based chemotherapy was introduced to our institution) to 1989, 150 patients had persistent disease at SLL. Relevant clinical information was extracted through retrospective chart review.

Results: One hundred forty-five patients were followed until death, with a median follow-up of 15.4 years for the 5 living patients. Median actuarial survival from the time of SLL was 18 months. Tumor grade (P = 0.003) and pre- and post-SLL tumor size (P < 0.0001) were significant determinants of survival by univariate analysis. Patients with microscopic disease or those with < or =1 cm disease rendered microscopic at SLL had improved survival relative to those with < or =1 cm and macroscopic disease following SLL (P = 0.03) (median survivals of 3.3, 2.5, and 1.4 years, respectively). In contrast, median survival of those with >1 cm disease cytoreduced to microscopic disease was no different than those with macroscopic residual, even if < or =1 cm (1.3 and 1.0 years, respectively). After adjusting for tumor size, salvage treatment was not a significant predictor of survival.

Conclusion: With long-term follow-up there was no suggestion that the type of salvage therapy (e.g., P32 or WART) influenced survival. Rather, low-grade disease and low tumor burdens following cytoreduction were associated with improved survival on multivariate analysis.

MeSH terms

  • Aged
  • Chemotherapy, Adjuvant
  • Female
  • Follow-Up Studies
  • Humans
  • Laparotomy
  • Middle Aged
  • Neoplasm Recurrence, Local / pathology*
  • Neoplasm Recurrence, Local / radiotherapy
  • Neoplasm Recurrence, Local / surgery
  • Neoplasm Recurrence, Local / therapy*
  • Organoplatinum Compounds / therapeutic use
  • Ovarian Neoplasms / pathology*
  • Ovarian Neoplasms / radiotherapy
  • Ovarian Neoplasms / surgery
  • Ovarian Neoplasms / therapy*
  • Retrospective Studies
  • Salvage Therapy
  • Second-Look Surgery
  • Survival Rate
  • Treatment Outcome


  • Organoplatinum Compounds