Second look laparotomy:
Is performed on a patient with no clinical evidence of persistant tumour for the purpose of determining disease status after a planned interval of treatment with chemotherapy.
It is identical to staging laparotomy. Vertical midline incision to be given.
Cytological washings can be taken. Complete abdominal inspection and palpation can be done.
Biopsy from persistant disease, peritoneal surfaces, omentum, retroperitoneal nodes, sites of previously documented tumour,adhesions can be taken.
Laparoscopy is an alternative.
Findings :
Negative : grossly and pathologically negative (30-50%). Microscopically positive : grossly negative, pathologically positive (20%).
Macroscopically positive : grossly and pathologically positive (30-50%).
Variables associated with outcome are initial stage, tumour grade,size of the residual tumour and largest metastatic tumour before treatment.
Findings correlate with subsequent outcome and survival.
Not recommended as it did not influence the survival.
Performed selectively in setting where clinical trials are going on secondary cytoreductive surgery. Cytoreductive surgery performed in patients whoare partial responders or non-responders to primary chemotherapy.
Have recurrence after primary therapy and prolonged disease free interval off therapy (> 6 months). Undergo a suboptimal debulking followed by chemotherapy.
Have persistant macroscopic tumour at second-look laparotomy. Principal setting is for platinum-sensitive recurrent disease.
Is performed on a patient with no clinical evidence of persistant tumour for the purpose of determining disease status after a planned interval of treatment with chemotherapy.
It is identical to staging laparotomy. Vertical midline incision to be given.
Cytological washings can be taken. Complete abdominal inspection and palpation can be done.
Biopsy from persistant disease, peritoneal surfaces, omentum, retroperitoneal nodes, sites of previously documented tumour,adhesions can be taken.
Laparoscopy is an alternative.
Findings :
Negative : grossly and pathologically negative (30-50%). Microscopically positive : grossly negative, pathologically positive (20%).
Macroscopically positive : grossly and pathologically positive (30-50%).
Variables associated with outcome are initial stage, tumour grade,size of the residual tumour and largest metastatic tumour before treatment.
Findings correlate with subsequent outcome and survival.
Not recommended as it did not influence the survival.
Performed selectively in setting where clinical trials are going on secondary cytoreductive surgery. Cytoreductive surgery performed in patients whoare partial responders or non-responders to primary chemotherapy.
Have recurrence after primary therapy and prolonged disease free interval off therapy (> 6 months). Undergo a suboptimal debulking followed by chemotherapy.
Have persistant macroscopic tumour at second-look laparotomy. Principal setting is for platinum-sensitive recurrent disease.
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