["Second-look" surgery and diagnostic laparoscopy in the combined and comprehensive therapy of patients with ovarian cancer].

The data on 503 cases of ovarian malignancies were evaluated to work out indications for and clinical assessment of revision laparotomies. Second-look surgery was carried out in the following situations: (1) tumor elements found in the washings of the peritoneum in Douglas' space and high blood-serum levels of CA-125 (8 patients with stage I-II tumors, in clinical remission); (2) during remission, after 6-10 courses of polychemotherapy (13 patients with stage III-IV tumors); (3) during remission, after non-radical primary surgery (117); (4) suspected recurrence (144); (5) recurrence-free surgical pathology, e.g. ventral hernia, requiring laparotomy (22). Patients without repeated laparotomy (199) were in control. During remission, surveillance can be carried out using cytologic, ultrasound and immunoradiologic techniques since laparoscopy fails. The latter is useful, for diagnostic purposes, in case of discrepancy between clinical and ultrasound evidence as well as during monitoring in patients in clinical remission who show unfavorable levels of CA-125 and poor results of sonographic. Laparotomy is indicated prior to chemotherapy of inoperable tumors for morphologic verification of diagnosis. Indications for second-look operations can be significantly decreased considering the latest improvements in non-invasive monitoring technique. Laparoscopic examination can effectively serve the same purposes.