Fertility-Sparing Surgery for Ovarian Cancer.

Geoffroy Canlorbe,Catherine Uzan,Nathalie Chabbert-Buffet

doi:10.3390/jcm10184235

Abstract

(1) Background: although most patients with epithelial ovarian cancer (EOC) undergo radical surgery, patients with early-stage disease, borderline ovarian tumor (BOT) or a non-epithelial tumor could be offered fertility-sparing surgery (FSS) depending on histologic subtypes and prognostic factors. (2) Methods: we conducted a systematic review to assess the safety and fertility outcomes of FSS in the treatment of ovarian cancer. We queried the MEDLINE, PubMed, Cochrane Library, and Cochrane (“Cochrane Reviews”) databases for articles published in English or French between 1985 and 15 January 2021. (3) Results: for patients with BOT, FSS should be offered to young women with a desire to conceive, even if peritoneal implants are discovered at the time of initial surgery. Women with mucinous BOT should undergo initial unilateral salpingo-oophorectomy, whereas cystectomy is an acceptable option for women with serous BOT. Assisted reproductive technology (ART) can be initiated in patients with stage I BOT if infertility persists after surgery. For patients with EOC, FSS should only be considered after staging for women with stage IA grade 1 (and probably 2, or low-grade in the current classification) serous, mucinous or endometrioid tumors. FSS could also be offered to patients with stage IC grade 1 (or low-grade) disease. For women with serous, mucinous or endometrioid high-grade stage IA or low-grade stage IC1 or IC2 EOC, bilateral salpingo-oophorectomy and uterine conservation could be offered to allow pregnancy by egg donation. Finally, FSS has a large role to play in patients with non- epithelial ovarian cancer, and particularly women with malignant ovarian germ cell tumors.

Highlights

The aim of conservative and functional surgery in an oncology setting is to preserve an organ’s functionality and to avoid radical resection when possible
These results suggest that women with mucinous borderline ovarian tumor (BOT) should undergo initial unilateral salpingo-oophorectomy, whereas cystectomy is an acceptable option for women with serous BOT, which has a lower risk of lethal recurrence, in the absence of other high-risk factors
Three main factors impact fertility rates: the type of fertility-sparing surgery (FSS) performed, the patient’s age, and the histologic subtype of the tumor. Both the cumulative pregnancy rate and cumulative probability of a first pregnancy were found to be higher after cystectomy compared with salpingooophorectomy and collateral cystectomy [8,9]

Summary

Introduction

The aim of conservative and functional surgery in an oncology setting is to preserve an organ’s functionality and to avoid radical resection when possible. This approach is increasingly used in oncologic gynecologic surgery where fertility-sparing surgery (FSS). Aims to preserve the ovarian tissue and the uterus. Ovarian cancers are classified into epithelial (including borderline ovarian tumors (BOT) and malignant ovarian tumors) and non-epithelial cancer. Most patients with epithelial ovarian cancer will undergo radical surgery -the gold standard-patients with early-stage disease, BOT, or a non-epithelial tumor could be offered FSS depending on histologic subtypes and prognostic factors [3,4]

Methods

Results

Conclusion