Obstetric outcomes after conservative management of ovarian borderline tumors in women of reproductive age: A single center experience

Abstract

Objective: The main goal of fertility-sparing treatment is pregnancy followed by live birth (i.e., successful pregnancy). The principal objective of our study was to evaluate the successful pregnancy rate in patients with borderline ovarian tumors (BOTs) after conservative treatment. The second goal was to evaluate the safety of the conservative approach. Study design: 110 patients with BOT were retrospectively evaluated. All patients underwent surgical treatment, sparing the uterus and part of at least one ovary. Results: The median age was 28 years (range 17-40 years). Serous and mucinous tumors were found in 63 (57%) and 34 (31%) women, respectively. FIGO stage I, II, and III was diagnosed in 101 (91.8%), 3 (2.7%), and 6 (5.5%) patients, respectively. The 3-and 5-year progression-free survival was 82.5% and 78.2%, respectively. Recurrent disease was treated conservatively in 14 women, whereas 3 patients underwent radical surgery. Fifty-six (50.9%) patients got pregnant and had at least one live birth. A total of 83 children were born. A significant difference in the successful pregnancy rate was found in patients diagnosed 35 years vs. > 35 years old (55.6% vs. 9.1%, respectively; p = 0.003). Surgical approach (laparoscopy vs. laparotomy) did not influence the chance of childbirth. Pre-term delivery constituted 6.25% of all births. Conclusions: Fertility-sparing surgery should be proposed to young women wishing to preserve fertility. The rate of spontaneous pregnancy is approximately 50%.The risk of relapse is significant but always of borderline histology and may be successfully treated by the second surgery.

Does controlled ovarian hyperstimulation in women with a history of borderline tumor influence recurrence rate?

“…For young women who want to retain fertility, it is recommended to perform fertility preservation surgery. The incidence of spontaneous pregnancy is about 50% [ 35 ]. Although the risk of recurrence was significantly associated with fertility preserving surgery, it had no effect on the survival rate of patients.…”

Reproductive Results in Cancer Survivors after Fertility Sparing Management: The Need for the Standardization of Definitions

“…Some authors have avoided using rates, and they have presented the results as crude numbers [15,16]. Sobiczewski et al defined a successful pregnancy as a pregnancy that ended in childbirth [17]. Fang et al used the term "successful pregnancy", but they did not specify whether this term meant clinical pregnancy per se or pregnancy that ended in a live birth [18].…”

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.…”