Stage III-IV epithelial carcinoma of the ovary: is the second-look operation of any value for the patient?

A second-look operation (SLO) was performed in 18 of 24 patients operated for Stage III-IV epithelial carcinoma of the ovary in order to assess the effect of chemotherapy and to decide if further treatment, such as radiation therapy, was indicated. All patients had postoperative combination chemotherapy: either with PA [Platinol (Bristol, UK) and adriamycin] or with CHAD (cyclophosphamide, hexamethylmelamine, adriamycin and cis-diamminedichloroplatinum). In 7 of 18 (39%) patients who had SLO following chemotherapy, macroscopic tumor was present; in 7 (39%) patients, microscopic residual or recurrent disease was found, as proven by histological examination of the biopsies taken during the operation. Only in four patients (29.7%) was the SLO negative. Of these patients, three had recurrent disease after 3,6 and 7 months postoperatively. These findings indicate that the SLO was noncontributory to the management of the patients. The role of the SLO commonly used in most current treatment protocols of patients with Stage III-IV epithelial carcinoma of the ovary is questionable and requires further evaluation.