Ewha Med J.  2019 Apr;42(2):15-19. 10.12771/emj.2019.42.2.15.

Is Second Look Laparoscopy for Diagnosing Remaining Ovarian Cancer Appropriate Further Treatment?

• Inamdar R
• Cho A
• Yoo HK
• Moon HS

• KMID: 2444726
• DOI: http://doi.org/10.12771/emj.2019.42.2.15

Abstract

OBJECTIVES
The aim of our study is to compare the findings of investigative modalities and second look laparoscopy in ovarian cancer and establish the safety and accuracy of second look laparoscopy for detecting ovarian cancer.
METHODS
We retrospectively reviewed 11 patients with ovarian cancer treated by a single surgeon from 2006 to 2013. These patients were diagnosed at the time of primary cytoreductive surgery and received six cycles of combination chemotherapy. Then, they underwent second look laparoscopy. They were followed up with tumor markers monthly and PET-CT and/or CT scans.
RESULTS
All 11 patients had undergone primary surgery followed by six cycles of consolidation chemotherapy. Eight patients had positive pathologic findings on second look laparoscopy (72.7 %). The CA 125 level was higher in one patient (12.5%). In seven patients who had positive results on second look laparoscopy, the value was well below normal limits (87.5%). Three patients had recorded increases in fluorodeoxyglucose uptake (37.5%). The increase in standardized uptake values in specific regions in the scans corresponded to positive biopsies from those regions. Seven patients who had positive findings on second look laparoscopy were treated with consolidation chemotherapy. The 5-year survival rate was 66.67%, and the 5-year recurrence rate was 33.33%.
CONCLUSION
There are limitations to the accuracy of current investigative techniques, and we must rely on clinical correlation with these modalities for each case of second look laparoscopy. It is feasible to safely perform second look laparoscopy to detect remnant ovarian cancer.

Keyword

Second look; Laparoscopy; Ovarian neoplasms

MeSH Terms

Biomarkers, Tumor
Biopsy
Consolidation Chemotherapy
Drug Therapy, Combination
Humans
Investigative Techniques
Laparoscopy*
Ovarian Neoplasms*
Recurrence
Retrospective Studies
Survival Rate
Tomography, X-Ray Computed
Biomarkers, Tumor

Figure

• 

  Fig. 1 Pre-second look laparoscopy PET-CT results. Arrows are indicating area of FDG uptakes. Increasing in FDG uptake on right periexternal vessel area (patient 3) (A), omental seeding (patient 4) (B), left paraspinal area of L2 spine, false positive (patient 9) (C), and right posterior side from bladder (patient 11) (D).

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