Fertility preserving surgery in carcinoma ovary: a single institution experience

Abstract

Conventional treatment of ovarian cancer includes removal of the uterus and both ovaries. Use of fertility preservation surgery (FPS) has been steadily rising due to late marriages/ pregnancy combined with an increase in the number of patients diagnosed with early stage ovarian cancer. We present our series of ovarian cancer patients in whom FPS was done. We retrospectively analyzed cases of ovarian cancer in which FPS was carried out between 2011 to 2017 at our hospital. All patients diagnosed with ovarian cancer stage I-III who underwent comprehensive surgical staging and in whom the uterus and contralateral ovary was preserved either at laparoscopy or by open technique were included in the analysis. Thirty one patients (31) underwent FPS . The mean age was 23 years (range 11–33). Twenty three were operated upfront and 8 after neoadjuvant chemotherapy. Germ cell tumors (GCT’s) were the most common histology (17 patients) followed by epithelial ovarian cancers (8- invasive and 4 -borderline) only 2 patients had granulosa cell tumours. Amongst GCT’s, 4 were dysgerminomas and 13 non-dysgerminomatous tumors (6- immature teratomas, 3 yolk sac tumors and 4 mixed germ cell tumors). 24 patients were in stage IA, 2 in stage IC, 1 in stage IIB, 2 in stage IIIB and 2 in stage IIIC. After a median follow up of 40 months, 3 patients (9.6%) were lost to follow up. There were 4 recurrences; 2 patients were FIGO stage IA, one FIGO stage IC and the other was FIGO stage IIIB. None of them had grade 3 tumors. The overall survival was 92.85 % and recurrence free survival was 85%. Fourteen (14), (50%) patients were unmarried at the time of analysis and 7 of the remaining 14 patients already had a child and did not plan for another. Seven(7) patients planned to start their family, 2 patients (28.6%) conceived and both had full term normal pregnancy with live birth. Fertility-preserving surgery should be considered for young ovarian cancer patients who want to preserve their fertility. The decision regarding fertility preservation in higher stage (more than stage 1A) and high grade (grade 3) tumors should be taken only after adequate patient counseling regarding the risks of recurrence and chances of retaining fertility.