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doi:10.1016/j.ygyno.2005.11.040 
Copyright © 2005 Elsevier Inc. All rights reserved.
Identification of prognostic factors after positive second-look surgery in epithelial ovarian carcinoma
Wayne A. McCreatha, 1, Eric L. Eisenhauera, Nadeem R. Abu-Rustuma, Ennapadam S. Venkatramanb, Aileen Caceresc, Rachel Biera, Jae Huha, Jae Choa, Richard R. Barakata and Dennis S. Chia, 
, 
Received 22 June 2005.
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Abstract
Objective.
The objective of this study was to identify independent prognostic factors for survival in patients with epithelial ovarian cancer who had persistent disease identified at second-look surgery.
Methods.
We performed a retrospective chart review of all patients with epithelial ovarian cancer who had positive findings at second-look surgery between June 1991 and June 2002. All patients achieved a complete clinical remission after a prescribed course of primary therapy. Survival was determined from the time of second-look surgery until last follow-up or death.
Results.
The study included a total of 262 patients, with a median age of 54 years (range, 22–80). Of the 262 patients, 166 (63%) had died of disease. Records of initial (salvage) treatment after the positive second-look surgery were available for 243 patients. Therapies included the following: intraperitoneal (IP) cisplatin, 71 (29%); IP cisplatin combined with a second drug, 53 (22%); IP therapy other than cisplatin, 29 (12%); intravenous (IV) chemotherapy, 50 (21%); IP and IV therapy, 35 (14%); and oral chemotherapy, 5 (2%). Of the 13 potential prognostic factors analyzed, only 2 factors emerged that, when combined, were significant—residual disease after primary surgery and size of persistent disease found at second-look surgery. Patients with ≤1 cm residual disease after primary surgery and microscopic disease at second-look surgery had significantly improved survival.
Conclusion.
In our analysis, the only prognostic factor for survival in patients with positive second-look procedures was a combination of residual disease after primary surgery and size of persistent disease identified at second-look surgery. No individual chemotherapy treatment imparted a survival advantage. Novel that therapeutic approaches are needed in this setting.
Keywords: Prognostic factors; Ovarian cancer; Second-look surgery
