Abstract
BackgroundThere is as yet limited evidence about fertility-sparing surgery for early ovarian cancer (EOC) carried out laparoscopically. We sought to analyze recurrence patterns and fertility outcome in a cohort of ovarian cancer patients who underwent fertility-saving laparoscopic surgical staging.MethodsWe conducted a retrospective analysis of prospectively collected data on all patients undergoing fertility-sparing laparoscopic staging procedures for presumed EOC at a single gynecologic oncology service. Oncologic safety and reproductive outcome were the main outcome measures. The pertinent literature is reviewed.ResultsThe study cohort consisted of 12 women. Cases included 5 invasive epithelial tumors and 7 nonepithelial tumors. The disease was reclassified to a higher stage in one woman. After a median follow up period of 38 months (range: 14–108), the overall survival was 100% and recurrence-free survival 90.9%. Five (100%) of patients who attempted pregnancy conceived spontaneously. Three of them had uneventful term pregnancy delivering healthy babies. The literature search yielded 62 cases of laparoscopic fertility conserving surgery for ovarian cancer. There were 4 (6.2%) recurrences. Cumulative pregnancy and live birth rate were not estimable as earlier publications lack essential data.ConclusionsLaparoscopic staging may represent a viable option for premenopausal women seeking fertility preservation in the setting of early ovarian cancer. More research is needed to determine whether laparoscopy may offer reproductive benefits to this particular population.
Highlights
There is as yet limited evidence about fertility-sparing surgery for early ovarian cancer (EOC) carried out laparoscopically
There are no randomized trials comparing the traditional comprehensive staging to fertility-sparing surgery and it is unlikely that such a trial will ever be conducted
We report our experience with laparoscopic treatment of premenopausal women seeking fertility preservation in the setting of a unilateral ovary-confined ovarian cancer and we review currently available data regarding the results of fertility-sparing minimally invasive surgery for EOC
Summary
There is as yet limited evidence about fertility-sparing surgery for early ovarian cancer (EOC) carried out laparoscopically. The demand for fertilitysparing options grows among young women with cancer, Accumulated experience indicates that the oncologic results following conservative treatment with retention of the uterus and contralateral ovary are reassuring and similar to standard staging, and shows acceptable recurrence rates [4,5,6]. Unlike what occurred with endometrial and cervical cancer, the widespread acceptance and adoption of laparoscopic staging of early ovarian cancer (EOC) has been much slower and minimal access surgery in this context is still regarded as investigational, despite initial recognition of its role by leading oncology societies [13,14]
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