J Gynecol Oncol.  2014 Oct;25(4):320-327. 10.3802/jgo.2014.25.4.320.

Fertility sparing surgery in early stage epithelial ovarian cancer

• Ditto A
• Martinelli F
• Lorusso D
• Haeusler E
• Carcangiu
• Raspagliesi F

• KMID: 2130121
• DOI: http://doi.org/10.3802/jgo.2014.25.4.320

Abstract

OBJECTIVE
Fertility sparing surgery (FSS) is a strategy often considered in young patients with early epithelial ovarian cancer. We investigated the role and the outcomes of FSS in eEOC patients who underwent comprehensive surgery.
METHODS
From January 2003 to January 2011, 24 patients underwent fertility sparing surgery. Eighteen were one-to-one matched and balanced for stage, histologic type and grading with a group of patients who underwent radical comprehensive staging (n=18). Demographics, surgical procedures, morbidities, pathologic findings, recurrence-rate, pregnancy-rate and correlations with disease-free survival were assessed.
RESULTS
A total of 36 patients had a complete surgical staging including lymphadenectomy and were therefore analyzed. Seven patients experienced a recurrence: four (22%) in the fertility sparing surgery group and three (16%) in the control group (p=not significant). Sites of recurrence were: residual ovary (two), abdominal wall and peritoneal carcinomatosis in the fertility sparing surgery group; pelvic (two) and abdominal wall in the control group. Recurrences in the fertility sparing surgery group appeared earlier (mean, 10.3 months) than in radical comprehensive staging group (mean, 53.3 months) p<0.001. Disease-free survival were comparable between the two groups (p=0.422). No deaths were reported. All the patients in fertility sparing surgery group recovered a regular period. Thirteen out of 18 (72.2%) attempted to have a pregnancy. Five (38%) achieved a spontaneous pregnancy with a full term delivery.
CONCLUSION
Fertility sparing surgery in early epithelial ovarian cancer submitted to a comprehensive surgical staging could be considered safe with oncological results comparable to radical surgery group.

Keyword

Disease-free survival; Fertility; Lymph node excision; Neoplasm recurrence; Ovarian neoplasms; Pregnancy

MeSH Terms

Adult
Female
Fertility
Fertility Preservation/*methods
Humans
Infertility, Female/prevention & control
Lymph Node Excision
Lymphatic Metastasis
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Neoplasms, Glandular and Epithelial/pathology/*surgery
Ovarian Neoplasms/pathology/*surgery
Pregnancy
Pregnancy Outcome
Retrospective Studies
Survival Analysis
Treatment Outcome
Young Adult
Ovarian epithelial cancer

Figure

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  Fig. 1 Disesase free survival (DFS) in two groups of patients with early epithelial ovarian cancer undergoing conservative (fertility sparing surgery, FSS) versus radical (radical comprehensive staging, RCS) treatment (Log-rank test, p=0.422; FSS: mean DFS 62.4 months, 95% confidence interval [CI], 48.7 to 76.2; RCS: mean DFS 89.1 months, 95% CI, 71.8 to 106.4).

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