Background: Although second-look laparotomy (SLL) remains the hallmark method for determining disease status after completion of adjuvant therapy, the inclusion of reassessment surgery in the treatment scheme of ovarian carcinoma has been challenged. Given the absence of prospective analyses addressing this issue, justification for continued use of SLL must demonstrate benefits regardless of the outcome of the procedure.
Results: In the absence of residual disease, either the recurrence rate after SLL should be acceptably low or the outcome should permit identification of specific groups that would benefit from consolidation therapy. The characteristics associated with a significant risk for recurrence after a negative SLL include patient age, histologic grade, and the amount of residual disease after the primary cytoreduction operation. The postoperative benefits of positive SLL findings must be manifested in enhanced survival rates after secondary cytoreduction surgery, salvage therapy, or both. Recent evidence suggests that tumor reduction during SLL and contemporary salvage methods favorably influence specific subgroups of patients.
Conclusions: The criteria for continued use of SLL in advanced epithelial ovarian cancer should include the availability of (and preferably prospective clinical trials for) both consolidation and salvage therapy to which all patients with ovarian cancer optimally would be afforded access.