Second-look laparotomy in ovarian cancer.

The role of the second-look laparotomy has become standard management in the patients with ovarian cancer without any objective evidence that it has a major impact on survival. In patients with early-stage disease, data on second-look surgery would suggest that there is very little, if any, benefit in patients who have had optimal full surgical staging and appropriate postoperative therapy. In advanced disease, even if the second-look laparotomy is negative, one-half will develop a recurrence. The role of the second-look laparotomy as a secondary debulking procedure has been suggested by some but appears to be beneficial in only a small subset of patients--less than 10%. In patients being treated on protocol, a second-look laparotomy has become the gold standard for determining effectiveness of a specific treatment being evaluated and would tend to be justified in this group to increase our knowledge and hopefully arrive at a better postsurgical therapy.