Fertility Preserving Surgery Outcomes for Ovarian Malignancy: Data from a Tertiary Cancer Centre in Central London

Abstract

Fertility Sparing Surgery (FSS) appears to be a safe means of treating early-stage ovarian cancer based on relatively limited evidence. However, there is currently insufficient evidence to aid women in counselling about their potential fertility outcomes. The aim of this study was to assess the reproductive outcomes and prognosis of women who have undergone FSS for ovarian malignancy. Between 1 June 2008 and 1 June 2018, a retrospective review of a clinical database was conducted to identify all consecutive patients who underwent FSS in a central London gynaecological oncology centre. All patients with a histological diagnosis of ovarian malignancy (excluding borderline ovarian tumours) were eligible. All identified patients were then prospectively called into a follow up and asked to complete a questionnaire about their fertility outcomes. A total of 47 women underwent FSS; 36 were included in this study. The mean age was 30.3 years (95% Confidence Interval [CI]: 27.6 to 33.0 years). During the study period, 17/36 (47.2%) of the women had attempted to conceive following surgery, with a successful live birth rate of 52.9% (9/17). The mean time of recurrence was 125.3 months (95% CI: 106.5–144.1 months). The mean time to death was 139.5 months (95% CI: 124.3–154.8). The cancer grade, tumour stage and use of Assisted Reproductive Technology (ART) were the main factors significantly associated with the risk of recurrence and death. In conclusion, this study suggests that a large proportion of women will not attempt to conceive following FSS. For those who do attempt to conceive, the likelihood of achieving a live birth is high. However, careful counselling about the higher risk of recurrence and worse survival for women with high grade cancer, disease Stage > IA and potentially those who undergo ART is essential before contemplating FFS.

Comments on the definition of ovarian cancer stage IC2, related to fertility-sparing treatment

“…Similarly, Gaughran et al [10] conducted a study involving 36 patients and found a significant correlation between fertility-sparing surgery (FSS) and higher mortality rates for disease stage >1A (p = 0.02) and tumor grade >1 (p = 0.02). Disease recurrence was associated with disease stage >1A (p = 0.07) and the use of in vitro fertilization (IVF) (p = 0.03).…”

Current limits of conservative treatment in ovarian cancer

“…Data regarding reproductive outcomes in patients with conservative treatment of ovarian cancer should be interpreted carefully and without generalization. Successful conception rates vary between 30 and 60% with a rate of abortion from 4 to 17% [54,56 && , [70][71][72]. Otherwise, obstetrical outcomes (rate of malformation, miscarriages or preterm delivery) are not affected by conservative treatment.…”

Artificial Intelligence in Ultrasound Diagnoses of Ovarian Cancer: A Systematic Review and Meta-Analysis

“…The treatments offered to patients can differ significantly based on the provisional diagnosis from imaging modalities, prior to a confirmative histological diagnosis [5]. Benign masses can be monitored without intervention, or, depending on their size and symptoms, a limited resection with a low peri-operative risk can be performed and may be beneficial for patients desiring fertility preservation [6][7][8]. It is known that findings of unilocular cysts in premenopausal women that measure less than 5 cm are associated with a less than 1% risk of malignancy, and these can be managed conservatively [9].…”