Peritoneoscopy in the management of ovarian cancer.

The results obtained from the routine use of peritoneoscopy in the initial evaluation and follow-up of 99 patients with ovarian cancer treated at the National Cancer Institute between 1970 and 1978 have been analyzed. Prior to treatment, peritoneoscopy documented new sites of involvement undetected by conventional radiologic and isotopic procedures in 42 patients (48%) and provided the only evidence for follow-up of disease in 25 patients (28%). Twenty-one percent of patients referred with Stages I and II disease were upstaged to Stage III on the basis of diaphragmatic disease detected at peritoneoscopy. In the 66 restaging (posttreatment) peritoneoscopies, residual disease was found in 33 (50%) and peritoneoscopic findings provided the only evidence for disease in 24 cases (36%). These patients were spared an unnecessary second-look laparotomy. Twenty-two patients with negative peritoneoscopies underwent laparotomy. Residual ovarian cancer was found in 12 (55%), mainly in the pelvis and mesentery. Thus, a negative peritoneoscopy must be followed by a laparotomy before a patient with ovarian cancer can be considered disease free. Peritoneoscopy was found to be a safe and feasible procedure, even in patients who had prior laparotomies. It could not be performed for technical reasons in only 6% of the patients. There were few serious complications and in only 2.5% of the cases was medical therapy required to deal with a complication. There were no deaths or perforations of the viscus and no patient required surgical exploration because of a peritoneoscopy complication.