The outcomes of fertility sparing surgery in epithelial ovarian cancer

Conservative surgery has long been discussed as a treatment option in women with ovarian cancer at reproductive age. However, current guidelines recommend conservative surgery only in selected patients. There is considerable interest on pregnancy and delivery rates after fertility-sparing surgery (FSS), with several ongoing studies on this subject. The aim of the present multi-center study was to evaluate survival and pregnancy outcomes in patients that underwent fertility-sparing surgery. This retrospective study included 19 patients who underwent fertility-sparing surgery due to invasive epithelial ovarian cancer between 2002 and 2014. The median duration of follow-up was 59.5 months (range 10-152 months). A total of 10 full-term pregnancies and 3 spontaneous abortions occurred in 7 patients (36.8%) following FSS. Ten patients (52.6%) underwent prophylactic surgery after a median period of 49 months (16-119 months), while 2 patients (10.5%) developed recurrent disease after prophylactic surgery. Accurate staging in patients with early stage epithelial ovarian cancer and regular follow-up has shown promising reproductive outcomes. In light of the current data, fertility-sparing surgery should be considered in selected patients with stage I epithelial ovarian cancer. There is still no consensus, however, on the selection criteria of eligible patients for fertility-sparing surgery.

Epithelial ovarian cancer; Fertility-sparing surgery; Surgical staging

[1] Jemal A., Siegel R., Ward E., Murray T., Xu J., Smigal C., et al.: “Cancer statistics, 2006”. CA Cancer J. Clin., 2006, 56,106.

[2] McGuire W.P., Hoskins W.J., Brady M.F., Kucera P.R., Partridge E.E., Look K.Y., et al.: “Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer”. N. Engl. J. Med., 1996, 334, 1.

[3] FIGO cancer committee. Staging announcement. Gynecol. Oncol., 1986, 50, 383.

[4] Low J., Perrin L.C., Crandon A.J., Hacker N.F.: “Conservative surgery to preserve ovarian function in patients with malignant ovar- ian germ cell tumors. A review of 74 cases”. Cancer, 2000, 89, 391.

[5] Brewer M., Gershenson D.M., Herzog C.E., Mitchell M.F., Silva E.G., Wharton J.T.: “Outcome and reproductive function after chemotherapy for ovarian dysgerminoma”. J. Clin. Oncol., 1999, 17, 2670.

[6] Morice P., Camatte S., El Hassan J., Pautier P., Duvillard P., Cas- taigne D.: “Clinical outcomes and fertility after conservative treatment of ovarian borderline tumors”. Fertil. Steril., 2001, 75, 92.

[7] Duska L.R., Chang Y., Flynn C.E., Chen A.H., Goodman A., Fuller A.F., Nikrui N.: “Epithelial ovarian carcinoma in the reproductive age group”. Cancer, 1999, 85, 2623.

[8] Plaxe S.C., Braly P.S., Freddo J.L., McClay E., Kirmani S., Howell S.B.: “Profiles of women age 30–39 and age less than 30 with epithelial ovarian cancer”. Obstet. Gynecol., 1993, 81, 651.

[9] Rodriguez M., Nguyen H.N., Averette H.E., Steren A.J., Penalver M.A., HarrisonT., et al.: “National survey of ovarian carcinoma XII. Epithelial ovarian malignancies in women less than or equal to 25 years of age”. Cancer, 1994, 73, 1245.

[10] Swerenton K.D., Hislop T.G., Spinelli J., LeRiche J.C., Yang N., Boyes D.A.: “Ovarian carcinoma: a multivariate analysis of prog- nostic factors”. Obstet. Gynecol., 1985, 65, 264.

[11] Smedley H., Sikora K.: “Age as a prognostic factor in epithelial ovarian carcinoma”. Br. J. Obstet. Gynaecol., 1985, 92, 839.

[12] Di Saia P.J.: “Fertility-sparing treatment of patients with ovarian cancer”. Comprehens Ther., 1990, 16, 35.

[13] Borgfeldt C., Iosif C., Masback A.: “Fertility-sparing surgery and outcome in fertile women with ovarian borderline tumors and epithelial invasive ovarian cancer”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2007, 134, 110.

[14] Fruscio R., Corso S., Ceppi L., Garavaglia D., Garbi A., Floriani I., et al.: “Conservative management of early-stage epithelial ovarian cancer, results of a large retrospective series”. Ann. Oncol., 2013, 24, 138.

[15] Kajiyama H., Shibata K., Mizuno M., Nawa A., Mizuno K., Mat- suzawa K., et al.: “Fertility-sparing surgery in young women with mucinous adenocarcinoma of the ovary”. Gynecol. Oncol., 2011, 122, 334.

[16] Kwon Y.S., Hahn H.S., Kim T.J., Lee I.H., Lim K.T., Lee K.H., et al.: “Fertility preservation in patients with early epithelial ovarian cancer”. J. Gynecol. Oncol., 2009, 20, 44.

[17] Morice P., Leblanc E., Rey A., Baron M., Querleu D., Blanchot J., et al.: “Conservative treatment in epithelial ovarian cancer: results of a multicentre study of the GCCLCC (Groupe des Chirurgiens de Centre de Lutte Contre le Cancer) and SFOG (Societe Francaised’ Oncologie Gynecologique)”. Hum. Reprod, 2005, 20, 1379.

[18] Park J.Y., Kim D.Y., Suh D.S., Kim J.H., Kim Y.M., Kim Y.T., et al.: “Outcomes of fertility-sparing surgery for invasive epithelial ovarian cancer: oncologic safety and reproductive outcomes”. Gy- necol. Oncol., 2008, 110, 345.

[19] Satoh T., Hatae M., Watanabe Y., Yaegashi N., Ishiko O., Kodama S., et al.: “Outcomes of fertility-sparing surgery for stage I epithelial ovarian cancer: a proposal for patient selection”. J. Clin. Oncol., 2010, 28, 1727.

[20] Schilder J.M., Thompson A.M., DePriest P.D., Ueland F.R., Cibull M.L., Kryscio R.J., et al.: “Outcome of reproductive age women with stage IA or IC invasive epithelial ovarian cancer treated with fertility-sparing therapy”. Gynecol. Oncol., 2002, 87, 1.

[21] Zanetta G., Chiari S., Rota S., Bratina G., Maneo A., Torri V., et al.: “Conservative surgery for stage I ovarian carcinoma in women of child bearing age”. Br. J. Obstet. Gynaecol., 1997, 104, 1030.

[22] National Comprehensive Cancer Center: “Ovarian cancer clin- ical practice guidelines in oncology. Fort Washington: Na- tional Comprehensive Cancer Network; 2016”. Available at: http://www.nccn.org.

[23] Wright J.D., Shah M., Mathew L., Burke W.M., Culhane J., Goldman N, et al.: “Fertility preservation in young women with epithelial ovarian cancer”. Cancer, 2009, 115, 4118.

[24] Meier W.J.: “Lympnadenectomy in stage I ovarian cancer”. Proc. Am Sco Clin Oncol 2000, 19, 1541.

[25] Benedetti-Panici P., Greggi S., Maneschi F., Scambia G., Amoroso M., Rabitti C., et al.: “Anatomical and pathological study of retroperitoneal nodes in epithelial ovarian cancer”. Gynecol. Oncol., 1993, 51, 150.

[26] Petru E., Lahousen M., Tamussino K., Pickel H., Stranzl H., Stettner H., et al.: “Lymphadenectomy in stage I ovarian cancer”. Am. J. Obstet. Gynecol., 1994, 170, 656.

[27] Baiocchi G., Raspagliesi F., Grosso G., Fontanelli R., Cobellis L., Di Re E.: “Early ovarian cancer: is there a role for systematic pelvic and para-aortic lymphadenectomy”? Int. J. Gynecol. Cancer, 1998, 8, 103.