The prognostic significance of second-look laparotomy in advanced ovarian cancer.

The value of prognostic parameters in predicting the outcome of second look laparotomy (SLL) and survival after SLL was assessed in a series of 115 FIGO III and IV ovarian cancer patients. The prognostic parameters included age of patients, FIGO-stage, differentiation of tumour, maximum diameter of residual disease following the initial operation and clinical, cytologic and histologic results of SLL. No statistically significant difference was found between stage III and IV patients concerning the results of SLL (p = 0.99) and the same is true for the tumour differentiation (p = 0.1) and the age of the patient when first operated (p = 0.15). On the contrary, residual disease following the initial operation is shown to be prognostically significant (p = 0.001). As for the overall survival time, the amount of residual tumour after the SLL is shown to be the most important parameter (p = 0.0002).

Correlation of abdominal computed tomography scanning and second-look operation findings in ovarian cancer patients.

Abdominal computed tomography scanning (CT scan) was performed in 35 patients with ovarian carcinoma prior to undergoing a second-look operation. All patients were in complete clinical remission following 6 courses of chemotherapy. Results of the CT scans were compared and correlated with surgicopathological findings at second look. There were 9 true-positive, 12 true-negative, 2 false-positive, and 12 false-negative CT scan results. The sensitivity was 0.42, the specificity 0.85, diagnostic accuracy 0.6, positive predictive value 0.81, and the negative predictive value 0.50. Sensitivity was poor for omental, mesenteric, and peritoneal disease, better for metastases in lymph nodes, good for abdominal masses, and very good for ascites and disease in the liver. False-positive CT scan findings were due to either anatomic variations or adhesions and scarring resulting from postoperative changes. Four false-negative studies resulted from microscopic disease found at second look. In the remaining 8 false-negative studies, nodules or plaques more than 2 cm in diameter were not detected in the omentum (4 patients), in the mesentery and peritoneum (2 patients), and in the lymph nodes (2 patients). Due to a high false-negative rate, a normal CT scan cannot replace a second-look operation for accurate assessment of disease status.

A rare case of umbilical metastasis from primary ovarian carcinoma.

Umbilical metastases from primary ovarian cancer are rare. Metastases to the umbilicus are most commonly from primary gastrointestinal malignancies. The second most common metastases are of gynecologic origin. This is the nineteenth well-documented case reported of a primary ovarian cancer with umbilical metastasis.