A critical reassessment of second-look laparotomy in XXXX .

@entity1 @entity43 @entity5 @entity41
Eighty-eight @entity1 with @entity43 , treated by first-line chemotherapy, achieved a complete clinical response and underwent second-look laparotomy to assess the true pathologic status of their disease. Persistent @entity5 was found in 50 @entity1 (57%). Thirty-two of these (36%) had obvious gross @entity5 , whereas, 16 (18%) had microscopic disease. Thirty-eight @entity1 (43%) had no pathologic evidence of persistent @entity43 . With a follow-up of 6 to 60 months, 30 of these @entity1 (79%) remain without evidence of recurrence. Multivariate logistic regression analysis revealed three covariates that were independently significant in predicting continued disease-free status. These included: the greatest diameter of the largest @entity41 left at the primary operation; histologic features of the @entity5 ; and the diameter of the largest @entity5 aggregate found at initial operation. A mathematical model based on the most significant covariates was designed to assess the relative risk of any @entity1 having persistent @entity5 at second-look laparotomy. A comparison of the predicted to actual outcome revealed a sensitivity of the model of 88%, a specificity of 71%, and an accuracy of 77%. Second-look laparotomy represents the basis on which potentially curative second-line salvage therapy can be initiated. With an increasing period of follow-up and with greater numbers of @entity1 , it can potentially document a complete pathologic response to first-line therapy administered with curative intent, and identify @entity1 for additional, adjunctive therapy, who are at risk of recurrence.
