2ND-LOOK LAPAROTOMY IN CARCINOMA OF THE FALLOPIAN-TUBE

Objective. To evaluate the role of second-look laparotomy following platinum-based chemotherapy in patients with fallopian tube cancer. Methods: We conducted a retrospective chart review of 35 patients with tubal cancer who underwent a second-look laparotomy following cytoreductive surgery and platinum-based combination chemotherapy. Results: The distribution by stage was as follows: 1, three (9%); II, five (14%); III, 24 (69%); and IV, two (6%); one patient was inadequately staged. The tumor grade was recorded in 31 patients, and 80% of these were grade 2 or 3. Twenty-one of the 35 patients (60%) were found to be free of disease at second-look operation. Neither stage nor grade were predictive of findings at the second-look procedure, although none of the five patients with stage I disease and/or grade 1 tumor had disease found at second-look surgery. The absence of gross residual disease following primary surgery was the strongest predictor of disease-free status at second-look laparotomy (P < .01). With a mean follow-up of 50 months among the survivors, only four (19%) of the patients with no evidence of tumor at reexploration have had a recurrence. Conclusion: Second-look laparotomy provides useful prognostic information in patients with tubal cancer, approximately 80% of patients who have a negative second-look following platinum-based chemotherapy will remain disease-free.