Safety of conservative management and fertility outcome in women with borderline tumors of the ovary

Abstract

Objective To assess the safety of fertility-sparing treatment and the remaining chance of childbearing after surgery. Design Retrospective clinical study. Setting Gynecology department of a university teaching hospital. Patient(s) Seventy-five women underwent surgical management in our institution between 1986 and 2001 for borderline tumors of the ovary. Intervention(s) Fifty-nine patients were treated by radical, fertility-compromising surgery. The remaining 16 patients underwent conservative surgery, preserving the uterus and at least some functional ovarian tissue. Seven unilateral adnexectomies, one simple cystectomy, and two adnexectomies associated with contralateral cystectomy were performed. Main outcome measure(s) Recurrence, survival, and pregnancy rates. Result(s) The observed recurrence rates after radical and conservative surgery were 0.0% and 18.7%, respectively. No disease-related deaths occurred in any group; there is no significant difference in survival rates. We can report 12 pregnancies in 7 of 11 women who underwent fertility-sparing management and who wished to become pregnant. Conclusion(s) In certain circumstances, conservative management offers a safe solution for borderline tumors of the ovary. Recurrence is noted significantly more often after this type of treatment, but all cases of recurrent disease can be detected with close follow-up and can be treated accordingly. No significant change in survival rates was found. Moreover, the pregnancy rate in women desiring pregnancy, those treated conservatively, was as high as 63.6%.