Place of second-look laparotomy after 18 courses of chemotherapy in epithelial ovarian cancer

Thirty-two patients with epithelial carcinoma of the ovary underwent a second-look laparotomy after the completion of an average of 18 courses of adjuvant chemotherapy. Nine patients (28%) were found to have persistent disease. This low rate of positive second-look laparotomy is probably because these patients received chemotherapy for 18 months and in those patients whose tumour did not respond to the medication, the disease would progress and the patient died without becoming a candidate for laparotomy. There was no stage Ic patient whose second-look laparotomy was positive and the need for second-look laparotomy is questionable in such patients. Stage III/IV patients and patients with recurrence had a significantly higher positive second-look laparotomy rate than stage Ic/II patients, 44% and 7% respectively. In the present group of patients with positive tumour at second-look laparotomy, 33% responded to further debulking operation and chemotherapy and remained disease free 15-33 months after completion of their second line chemotherapy treatment. For second-look laparotomy to be of maximum benefit to the patient, we recommend that it be performed after 12 courses of chemotherapy.