Abstract
Objective: To assess the role of FSS in women with early stage 1 ovarian cancer. Methods: This was a retrospective analytic study of the results of treatment of 24 patients all under 40 years of age who underwent a full conservative staging laparotomy procedure in oncology center of El Shatby Maternity hospital, Alexandria University in the period of one year from October 2019 to September 2020. All patients were followed up for a six month period following surgery by the pre-operatively elevated tumor marker and by a CT abdomen and pelvis to detect any tumor recurrence. Results: The mean age at diagnosis was 24.29 Years. 6/24 (25%) of surface epithelial tumor were G1, 8/24 (33.3%) were G2, 4/24 (16.7%) were G3. 20/24 (83.3%) of patients were stage FIGO 1a, 4/25 (16.7%) were stage 1b, and none of them was stage 1c. 20/24 (83.3%) of patients were stage FIGO 1a, 4/25 (16.7%) were stage 1b, and none of them was stage 1c. Recurrence was reported in 3/24 of cases (12.5%), such 3 cases underwent unilateral SO plus a FCSLP. No recurrence was reported in cases of bilateral tumors that underwent unilateral SO and a contralateral cystectomy. 100% of recurrence was in epithelial tumors. 1/24 (4.1%) was clear cell, 1/24 (4.1%) was serous and 1/24 (4.1%) was mucinous. None of the endometroid tumors did recur. Also none of the non-epithelial tumors showed any recurrence. Tumors of G1 showed no recurrence, G2 tumors showed 33.3% recurrence and G3 tumors showed the highest recurrence rate (66.6%). Conclusion: ovarian FSS is a safe surgical option for nearly all OC patients with low risk of recurrence, with apparently early stage OC, after being confirmed by a FCSLP to exclude any occult metastasis (occult advanced stage OC), including those cases of early epithelial OC, germ cell and gonadal stromal tumors and it should be considered for patients who have a strong desire to keep their fertility.
Highlights
Ovarian cancer (OC) is a disease of postmenopausal females
No recurrence was reported in cases of bilateral tumors that underwent unilateral SO and a contralateral cystectomy. 100% of recurrence was in epithelial tumors. 1/24 (4.1%) was clear cell, 1/24 (4.1%) was serous and 1/24 (4.1%) was mucinous
Conclusion: ovarian fertility sparing surgery (FSS) is a safe surgical option for most OC patients with low risk of recurrence, with apparently early stage OC, after being confirmed by a Full conservative staging laparotomy procedure (FCSLP) to exclude any occult metastasis, including those cases of early epithelial OC, germ cell and gonadal stromal tumors and it should be considered for patients who have a strong desire to keep their fertility
Summary
Ovarian cancer (OC) is a disease of postmenopausal females. Its median age of diagnosis is 63 years. 10% of cases of ovarian cancer occur in young age [1]. 10% of cases of ovarian cancer occur in young age [1] Those patients usually have positive family history of OC, such as cases have positive BRCA1 and BRCA2 gene mutations, that are more prone to develop OC at earlier age usually at their thirties. These ladies wouldn’t complete their family size and they want to preserve their fertility and reproductive potential. Screening of these patients with such gene mutation may allow early detection and the early possible intervention [2]. About 15% of those patients are candidates for ovarian fertility sparing surgery (FSS) [3]
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