Abstract
Introduction: Early-Stage Endometrial Cancer (ES-EC) presents a treatment challenge for women who would like to preserve their genital organs and complete their family planning. Delayed first pregnancy and aging of women in combination with high-definition sonography and cancer awareness is expected to increase the incidence of young women with ES-EC demanding Fertility Sparring Surgery (FSS). Methods: A thorough literature search was conducted using Medline (OVID), Embase, and Cochrane Library electronic databases in order to identify eligible studies published up to November 2021. Results: Age is an imperative determinator for FSS in ES-EC, since fertility potential is compromised with age and oocytes carrying higher risk of fragmented DNA. Favourable prognostic factors to FSS include, age younger than 35 years old, absent genetic predisposition to EC, fertile females with normospermic partners, negative histology for cancer cells after hysteroscopic biopsies and progesterone treatment, normal adnexal findings in Trans Vaginal Ultrasound (TVU), absent myometrial carcinomatous invasion in Magnetic Resonance Imaging (MRI) and absence of lympho-vascular involvement in Computerised Tomography Scan. Careful selection of patients based on favourable prognostic factors diminishes the risk of recurrence and allows for the opportunity of reproductive organs preservation until family planning is achieved in a reasonable time frame. Additionally, our review points out the need of hysteroscopic guidance in endometrial sampling for primary EC diagnosis as well as for the endometrial surveillance every 3-6 months follow-ups until pregnancy. Conclusion: After FSS decision, a strict time frame of one year to achieve pregnancy is essential in order to secure patient’s safety and to reduce the risk of early recurrency in EC.For both endometrial and ovarian cancer, prevention Hysterectomy and Bilateral Salpingo-oophorectomy should preferably be performed by the completion of child bearing age and before the age of 40 years. It is vital that the advantages and risks of FSS must be discussed openly, including the risk of undetectable by imaging occult gynecological cancer which can compromise life expectancy.
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