Chapters Index (French) French Version Welcome page Contact

For a certain number of tumours, surgery has been a very important tool to evaluate the response to chemotherapy.

One of the most typical examples has been the 'second look laparotomy' in ovarian carcinoma. This procedure was systematically performed in order to evaluate the response to chemotherapy and to enable the conclusion of treatment. In reality, it has been demonstrated that such surgery did not modify patient survival (probably because currently available salvaging treatment is insufficient for modifying disease evolution). Second laparotomy is nowadays only performed within clinical trials.

A variant was defined for ovarian carcinoma with an initial incomplete surgical procedure. A second laparotomy is planned after 3 months’ chemotherapy in the hope to perform the complete excision of each tumour nodule.

Post chemotherapy lymphadenectomies are another example. They are performed in order to assess the absence of any viable residual tumour.

For instance, in testicular cancer presenting with voluminous lumboaortic masses and for which persistent node masses are revealed by scanner after 4 chemotherapy courses:

The lymphadenectomy will specify the state of the nodes:

• either simple fibrosis and necrosis,
• or benign transformation of a malignant dysembryoma into a benign teratoma,
• or the persistence of viable malignant tumours.

In the first case, treatment is complete. In the second case, complete remission is obtained: removing the benign tumour avoids the risk of relapse in a malignant teratoma. In the third case, further chemotherapy is needed.

Nowadays, before practising such surgery, a Pet-Scan is performed. The first two cases do not show any FDG uptake (no viable tumour). FDG scintigraphy might avoid unnecessary surgery with its potential morbidity (anejaculation).