Role of conservative surgery in ovarian cancer: the European experience

Abstract

Although less frequently than in older women, about 15% of invasive epithelial ovarian cancer may occur in young women, for whom preservation of fertility potential is an important clinical goal. We reviewed the published evidences from the European literature on the role of conservative surgery in women with invasive epithelial ovarian cancer. Three reports were identified from the Italian and French literature; the data were analyzed together with our own experience in terms of relapse rate, relapse in the preserved ovary, survival, and fertility outcome. A total of 152 conservative surgeries were reported: 88 patients with stage IA, 2 with stage IB, 51 with stage IC, 2 with stage II, 3 with stage IIIA, and 6 with stage IIIC. Relapses occurred in 18/152 patients (11.8%) and involved the preserved ovary in 11 cases (7%). Fifty-three pregnancies were recorded with 38 uneventful term deliveries, 2 ectopic pregnancies, 6 spontaneous abortions, 4 terminations, and 2 with unknown outcome. Nine patients (5.9%) have died of disease. These findings confirm that young women with stage I invasive epithelial ovarian cancer may receive a successful treatment of their disease without sacrificing fertility.

Fertility-Sparing Surgery in Ovarian Cancer: A Systematic Review

“…A total of 15 studies [12,13,16,19,20,21,22,23,24,25,26,27,28,29,30] comprising 913 patients (11-43 years of age) met the inclusion criteria. In terms of assignability of recurrences to stage and grade, the cumulative analysis of data from 4 studies [13,20,22,30] published by Marpeau et al 2008 [31] contained more detailed information than some of the original publications and was therefore employed for the meta-analysis.…”

Fertility-sparing surgery for early stage epithelial ovarian cancer

“…When data from nine papers containing sufficient information about patients with Stage IA non-CCC and G2 disease (2,4,(10)(11)(12)(13)(17)(18)(19) were combined, although the recurrence-free rate was somewhat low, at 87.5% (70/80), the survival rate was high, at 95% (76/80) ( Table 3). One patient was alive with cancer, and for one the prognosis was unknown, but even if these two individuals were to be added to the number of deaths, the survival rate would still exceed 90%, at 92.5%.…”

Methods and conditions of fertility preservation in early-stage ovarian tumors

“…Azonban IA stádiumú, grade 3-as tumorok esetén, a legtöbb ajánlás szerint, nem javasolt fertilitást megőrző kezelést végezni [21,22,23,24]. IC stádium vagy világos sejtes carcinoma esetén megoszlanak a vélemények azzal kapcsolatban, hogy végezhető-e konzerváló műtét.…”

“…A kiújulásig eltelt idő medián értéke 21 A fenti adatok alapján az derül ki, hogy tumorkiújulás esetén nagyarányú a túlélés, amennyiben recidíva izolál-tan csak az ellenoldali petefészekben alakul ki. Extraovarialis kiújulás esetén azonban kedvezőtlen a prognózis.…”

“…Szintén vitatható kérdés, hogy fertilitást megtartó mű-tét során szükséges-e szövettani mintát venni az ellenoldali petefészekből, mivel az az esetek több mint 50%-ában szolgál a kiújulás helyéül [21,25]. Ugyanakkor egy kisméretű szövettani minta negatív eredménye esetén sem lehet biztosan kizárni egy megbúvó daganatot, és a mintavételi eljárás a megmaradt ép petefészekállományt csökkenti, roncsolja, ez pedig rontja a fertilitási képes-séget.…”