Role of second look laparotomy in multidisciplinary treatment and in the follow up of advanced ovarian cancer.

Surgical re-examination after first line surgery followed by chemotherapy is an absolutely necessary step in the course of integrated treatment of advanced ovarian epithelial tumours. Our personal experience of surgical re-staging and reductive surgery in 48 patients affected by ovarian tumours stage III and IV (FIGO), by laparotomic second look is reported. Repeated surgery succeeds in further reducing the neoplastic deposits or radicalizing the first intervention in 33% of the overall series; in 52% of the cases, the second look was negative for neoplasia; in 16% only, despite tumour finding no reductive surgery was possible. If only the cases presenting residual neoplasia after primary surgery are taken into account, tumour debulking was possible in 44% of the patients. The analysis of this series fully confirms the preliminary statement that the smaller the residual neoplasia after surgery, the greater the chances of success for chemotherapy in ovarian cancer. It confirms as well that the laparotomic second look is the only currently available way to usefully assess the full remission of the disease.