Fertility after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: A call to action

Abstract

Introduction Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly accepted as the best therapeutic option in primary and some secondary peritoneal malignancies. The ramifications of this procedure on fertility are unknown. The aim of this study was to assess the current association of CRS/HIPEC with fertility following surgery. Methods A review of patients who underwent CRS/HIPEC between 2009 and 2018 was performed. Female patients were included if they were between ages 18–50 at the time of surgery. Gynecologic and obstetric history before and following CRS/HIPEC was collected by phone interview. Results Of 48 eligible participants, 21 completed the survey. Sixty‐five percent of women underwent a total abdominal hysterectomy before or during CRS. Twenty‐nine percent of these women recall fertility counseling before CRS/HIPEC, while 14.3% saw a fertility specialist for consultation, and only one patient proceeded with oocyte cryopreservation before treatment. There were no pregnancies reported following treatment with CRS/HIPEC. Conclusion Few patients after CRS/HIPEC retain child‐bearing potential, partly due to the high rate of hysterectomy and oophorectomy at time of surgery. Efforts towards improved preoperative counseling, increased oocyte cryopreservation, and evaluating the safety of preserving reproductive organs at the time of surgery are needed.

Prognosis for Young Females with Pseudomyxoma Peritonei of Appendiceal Origin and Unilateral or Bilateral Ovaries Preserved During Cytoreductive Surgery

“…Our findings showed that PMP recurrence rates rose rapidly two years post-CRS, implying that women who underwent CRS with/without HIPEC for PMP with ovarian preservation should attempt to conceive as soon as possible when the recommended waiting period following therapy is complete (12,13). In other literature, two small retrospective studies and 5 case reports have investigated the feasibility of ovarian preservation in patients with PMP of appendiceal origin (14)(15)(16)(17)(18)(19)(20). One study in four women aged 28-35 years with PMP who sought to maintain fertility adopted a strategy that involved laparoscopy for disease staging followed by appendicectomy, irrigation of the abdominal and pelvic cavity with water, and stripping of macroscopic disease from the peritoneal surface of the pelvis and the surface of the ovaries.…”

Ovarian Papillary Adenocarcinoma in a Single Young Nullipara: Challenges of Management in a Low-Income Setting

“…Unlike in our case, few patients after cytoreductive surgery retain child-bearing potential due to the high rate of hysterectomy and oophorectomy at time of surgery [17]. Efforts towards enhanced preoperative counselling for cryopreservation, increased oocyte and embryo cryopreservation, and assessing the safety of conserving reproductive organs at the time of surgery are desirable [17].…”

The role of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) as second-line debulking in advanced ovarian cancer patients. A meta-analysis

“…35 Unfortunately, limited data have been conducted concerning number of female patients undergoing fertility preservation methods after cytoreduction in combination with HIPEC. 36 Thus, the need for an extended preoperative guidance concerning fertility options such as oocyte cryopreservation remains mandatory. 37…”