Advanced Epithelial Ovarian Carcinoma in Thai Women: Should We Continue to Offer Second-Look Laparotomy?
VASANT LINASMITA, M.D., F.A.C.O.G.*, SARIKAPAN WILAILAK, M.D.*, AMMARIN THAKKINSTIAN, M.Med.Stat. **, SOMKEART SRISUPUNDIT, M.D.*, SOMSAK TANGTRAKUL, M.D.*, NATHPONG ISRANGURA, M.D.*, SUNCHAI BULLANGPOTI, M.D.*
Affiliation : * Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, **Clinical Epidemiology Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Objective : To determine survival among patients with epithelial ovarian carcinoma (EOC) who underwent a second-look laparotomy (SLL) and those refusing the procedure. Also to analyze factor(s) influencing the survival of the patients. Method and Material : Medical records were reviewed of patients with advanced EOC who were clinically free of disease after primary surgery and platinum-based chemotherapy between January I, 1992, and December 31, 1998. All of them were offered SLL. Measurement outcomes include patient survival and disease-free survival.
Results : There were 50 patients with clinically complete remission after chemotherapy. Sixteen patients underwent SLL, and thirty-four patients refused the procedure (NSLL). Seven patients (43.8%) were reported to have positive SLL. After the median follow-up time of 35 months, 12 patients had died, and 5 patients were lost to follow-up. The median survival time for patients with SLL was about 60 months. Five-year survival rates of patients in the SLL, and NSLL groups were 37 per cent (95%CI = 7%-69%), and 88 per cent (95%CI = 65%-96%) respectively (P<0.001). The median time to relapse was about 25 months for patients with negative SLL. Five year disease-free survival rates of patients in the negative SLL, and NSLL groups were 28 per cent (95%CI = 4%-59%), and 54 per cent (95%CI = 34%-70%) respectively (P=0.251). By Cox regression analysis, tumor grade was the only significant prognostic factor influencing patients' survival (HR = 6, 95%CI of HR = 1.2-34.2).
Conclusion : The second-look laparotomy doesn't have a favorable impact on overall and disease-free survival. Tumor grade is the only independent prognostic variable for survival of the patients.
Keywords : Second-Look Laparotomy, Advanced Epithelial Ovarian Cancer
