Fertility-sparing Surgery In Patients Research Articles

Oncological and Reproductive Outcomes after Fertility-Sparing Surgery in Patients with Advanced-Stage Serous Borderline Ovarian Tumor: A Single-Center Retrospective Study.

Our study aimed to analyze the prognosis and reproductive outcomes of patients with advanced-stage serous borderline ovarian tumors (SBOTs) who underwent fertility-sparing surgery (FSS). This study included patients aged ≤ 45 years diagnosed with advanced-stage (International Federation of Gynecology and Obstetrics II and III) SBOTs who were treated with FSS. Conservative surgeries were performed in 65 patients with advanced-stage SBOT with a median age of 28 years (range, 16-44 years). Nine patients had invasive implants. The median follow-up was 81.7 months. Forty-six patients (70.8%) had a relapse (median time to first recurrence, 22.8 months). Thirteen patients subsequently developed recurrence as an invasive disease, and two died due to disease progression. After multivariate analysis, age < 30 years and incomplete cytoreduction were independent risk factors for recurrence. Invasive implants and postoperative residual tumors were significantly associated with shorter disease-free survival. Of 35 patients attempting to conceive, 12 underwent assisted reproductive technology. Additionally, 19 pregnancies, including 15 full-term births, were documented. FSS provides a good chance of reproductive success in women with advanced-stage SBOT who desire fertility preservation, but it has a high recurrence rate and risk of malignancy transformation. Patients with invasive implants should be strictly selected for FSS.

Survival analysis and obstetric outcomes in patients with early stage ovarian cancer undergoing fertility-sparing surgery

ObjectiveThe aim of the present study is to evaluate the long-term outcomes in patients with early stage ovarian cancer undergoing fertility-sparing surgery.MethodsThe present study performed a retrospective analysis of recurrence, pregnancy and survival of a total of 66 patients who were diagnosed with early stage ovarian cancer (stage I) in XXX Faculty of Medicine Hospital between 2004 and 2019. Of these patients, 16 had undergone fertility-sparing surgery, and the remaining 50 patients had undergone radical surgery.ResultsOf 66 eligible patients, 16 had undergone fertility-sparing surgery, and the remaining 50 patients had undergone radical complete surgery. When demographic and descriptive data are taken into consideration, the mean age was 32.6 ± 6.76 years in patients undergoing fertility-sparing surgery and 54.05 ± 10.8 years in patients undergoing complete surgery, and the difference between the groups was statistically significant (p = 0.001). Of patients undergoing fertility-sparing surgery, 11 (16.7%) had stage Ia disease (most common), 5 (7.5%) had stage Ic disease, whereas no patient with stage Ib disease was detected. Of patients undergoing complete radical surgery, 32 (48.5%) had stage Ia disease (most common), 1 (1.5%) had stage Ib disease with bilateral ovarian involvement, and stage Ic was the second most common disease stage. Also, stage Ic3 was the most common disease stage (8 patients, 12.1%) among those with stage Ic disease. The rate of recurrence was 4.5% (3 patients) in patients undergoing fertility-sparing surgery, and recurrences occurred at 37 months, 69 months, and 76 months, respectively. A patient with stage Ic3 disease and endometrioid type tumor who developed recurrence at 37 months died at 130 months. Of patients undergoing complete surgery, ten patients (15.2%) developed recurrence, and there was no significant difference between the two groups in terms of recurrence (p = 1.00). At the end of 15-year follow-up period, there was no significant difference between patients undergoing fertility-preserving surgery and those undergoing complete surgery in terms of mortality (p = 0.668).ConclusionThe observation of significant findings in terms of the rate of recurrence and disease-free survival following fertility-sparing surgery in patients with low-risk early stage ovarian cancer suggests that survival is positively affected in early stage ovarian cancer.

Survival Outcomes in the Patients of Ovarian Epithelial Carcinomas Treated with Fertility-Sparing Surgery: A Study from a Developing Country

Objective: To assess the outcomes of fertility-sparing surgery in patients with ovarian epithelial carcinoma treated at our centre.&#x0D; Study Design: Retrospective longitudinal study.&#x0D; Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital &amp; Research Center, Lahore Pakistan, from Jul 2001 to Aug 2015.&#x0D; Methodology: We studied 31 patients with ovarian epithelial carcinoma who underwent fertility-sparing surgery at Shaukat Khanum Memorial Hospital. The detail regarding patients and tumour characteristics, along with outcomes of the intervention, was obtained from secondary data kept in the electronic hospital information system.&#x0D; Results: A total of 132 patients with ovarian epithelial carcinoma were identified; 31 patients underwent fertility-sparing surgery (Stage-IA, n=19; Stage-IC, n=12). By histopathology, 14(45.0%) had mucinous cystadenocarcinoma, 7(22.6%) serous adenocarcinoma, 6(19.4%) endometroid, and 4(12.9%) with clear cell pathology. The mean duration of follow-up was 52.6±2.3 months (18-118 months) after fertility-sparing surgery. Five-year recurrence-free survival was 81.0%. (Three-year=89.0%), using the Kaplan-Meier graph. Three patients had successful pregnancies, with one having a twin pregnancy.&#x0D; Conclusion: Fertility-sparing surgery should be considered for children of early-stage epithelial ovarian carcinoma patients as it preserves fertility and endocrine function while avoiding recurrence.

Reproductive and oncological outcomes of fertility-sparing surgery in patients with stage I epithelial ovarian cancer: A systematic review and meta-analysis.

Objective:We meta-analyzed available evidence on fertility, survival, and cancer recurrence in patients with stage I epithelial ovarian cancer (EOC) after fertility-sparing surgery (FSS).Methods:We systematically reviewed PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials to identify studies reporting reproductive and oncological outcomes of patients with stage I EOC who underwent FSS. Random-effects models were used to calculate pooled rates of disease outcomes, along with 95% confidence intervals (CIs). Subgroup and sensitivity analyses were conducted to identify sources of heterogeneity in the data.Results:We included 23 observational retrospective studies involving 1126 patients. The pooled pregnancy rate was 30% (95% CI, 0.26–0.34), while the pooled natural conception rate was 26% (95% CI, 0.20–0.33). The pooled live birth rate was 27% (95% CI, 0.22–0.32). The pooled rate of EOC recurrence was 12% (95% CI, 0.09–0.14), which did not differ significantly from the rate among patients who underwent radical surgery (odds ratio, 0.77; 95% CI, 0.45–1.33).Conclusions:FSS is associated with good oncological outcomes but less than satisfactory reproductive outcomes. All in all, the procedure appears to be a safe alternative to radical surgery for EOC patients who want to preserve fertility.

Systematic Pelvic and Para-Aortic Lymphadenectomy During Fertility-Sparing Surgery in Patients With Early-Stage Epithelial Ovarian Cancer: A Retrospective Study.

ObjectiveThe implication of pelvic and para-aortic lymphadenectomy in surgical staging of early-stage epithelial ovarian cancer (eEOC) is still debated. Limited data are available about systematic lymphadenectomy during fertility-sparing surgery (FSS) in patients with eEOC.MethodsThe medical records of 38 patients with FIGO stage I EOC and below 40 years who underwent FSS at our hospital between January 2003 and December 2018 were retrospectively reviewed.ResultsAmong them, 18 patients (47.4%) underwent comprehensive lymphadenectomy, 11 patients (28.9%) underwent lymph node sampling, and 9 patients (23.7%) did not undergo lymphadenectomy. There was no statically significant difference in age, histology, grade, surgical approach, chemotherapy, and gestation among the three groups. With a median follow-up of 52.5 months (range: 24–153), three patients (7.9%) with FIGO stage IC EOC developed tumor recurrence. In these patients, progress-free survival (PFS) was 92.1%, and overall survival (OS) was 94.7%. No significant difference in the OS. Three patients had among all the patients, 15 patients (39.5%) had gestation after treatment, and 23 patients (60.5%) did not have gestation after treatment.ConclusionThe number of lymph nodes removed did not significantly affect survival eEOC with FSS. Systematic pelvic and para-aortic lymphadenectomy could not be performed for mucious eEOC patients with FSS if intraoperative freezing in confirmed and no suspicious lymph nodes are found. A better understanding of sentinel lymph node biopsy may help to identify whether the patient requires FSS.

Oncological and reproductive outcomes after fertility-sparing surgery in patients with seromucinous borderline ovarian tumor: Results of a large retrospective study

ObjectiveTo evaluate the oncological and reproductive outcomes in patients with seromucinous borderline ovarian tumors (SMBOT) treated with fertility-sparing surgery (FSS). MethodsWe retrospectively reviewed the medical records of patients with SMBOT who underwent surgery between 2000 and 2019. A centralized histological review was performed and recurrence rates were compared between different surgical procedures. ResultsA total of 105 patients fulfilled the inclusion criteria, of whom 65 underwent FSS and 40 were treated with radical surgery (RS). Fourteen patients had recurrent disease after a median follow-up time of 59.6 months (range: 22.1—256.8 months). All but one relapsed with SMBOT. There was no significant difference in disease-free survival (DFS) between the two groups (P = 0.141). Multivariate analysis showed that only bilateral involvement was associated with increased recurrence (P = 0.008). In the subgroup of patients treated with conservative surgery, there was no significant difference in DFS with regard to surgical procedures (ovarian cystectomy vs salpingo-oophorectomy, P = 0.487). Of the 12 patients in the FSS group who developed recurrence, 11 underwent a second round of FSS and all remained alive with no evidence of disease at the end of follow-up. Of 20 patients desiring pregnancy, 16 patients were successful and resulted in 17 term deliveries. ConclusionsFSS is feasible for young patients who wish to preserve their fertility. Patients initially treated with ovarian cystectomy may be managed by close surveillance if post-operative imaging are negative. Repeat FSS remains a valuable alternative for young patients with recurrent SMBOT after thorough communication.

Fertility-sparing surgery for patients with stage IC2 or IC3 epithelial ovarian carcinoma: any evidence of safety?

ObjectiveInvestigate the overall survival of patients with stage IC2/IC3 epithelial ovarian carcinoma undergoing fertility-sparing surgery.MethodsPatients aged <45 years diagnosed between January 2004 and December 2015 with epithelial ovarian carcinoma, who...

Analysis of Outcomes and Prognostic Factors after Fertility-Sparing Surgery in Patients with Early Stage Juvenile Granulosa Cell Tumor of the Ovary: Experience from a Tertiary Center

Study ObjectiveThe objective of the study was to analyze the oncological outcomes and prognostic factors in patients with early-stage juvenile granulosa cell tumor (JGCT) who underwent fertility-sparing surgery. Design, Setting, and ParticipantsAll patients with early-stage JGCT who underwent fertility-sparing surgery between January 1995 and December 2017 were reviewed retrospectively. InterventionsNone. Main Outcome MeasuresThe risk factors for recurrence and death in patients with early-stage JGCT were identified. ResultsThirty-five patients were eligible for the current study. The median age was 17 years (range: 4-30 years), and 10 patients were premenarchal. Nine patients were International Federation of Obstetrics and Gynecology stage IA, and 26 were stage IC. Eight subjects underwent complete staging, whereas 28 had no staging at their initial surgery. In those without initial staging, 3 patients who received initial unilateral salpingo-oophorectomy (USO) and 6 with initial cystectomy underwent secondary surgery for staging or USO with staging, respectively. At the time of the secondary staging operation, 1 of the subjects (treated with USO at initial surgery) was found to be stage III and was excluded from this study. Therefore, 8 patients underwent secondary staging surgery performed by laparoscopic surgery, and none of them suffered recurrence during follow-up. Fourteen of the 16 patients with complete staging surgery underwent lymphadenectomy, and none of them had lymph node metastasis. Thirty-one patients received adjuvant chemotherapy after surgery. Eight patients had disease recurrence after a median follow-up time of 51 months (range: 6-229 months), with a median time to recurrence of 4.5 months (range: 2-52 months). Six patients died of their disease. The 5-year disease-free and overall survival rates were 74.8% and 84.3%, respectively. Univariate analysis showed that incomplete staging surgery was associated with increased risk of recurrence (P = 0.029). Adjuvant chemotherapy was not associated with disease-free survival. Four patients had a total of 6 pregnancies, resulting in 6 live births. ConclusionComplete surgical staging is recommended for early-stage JGCT, but lymph node dissection can be omitted. Laparoscopic restaging surgery is feasible for patients with incomplete staging at initial surgery. However, the prognosis of patients with relapsed JGCT remains poor.

Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Cervical Cancer.

To evaluate outcomes of the first pregnancy after fertility-sparing surgery in patients with early-stage cervical cancer. We performed a population-based study of women aged 18-45 years with a history of stage I cervical cancer reported to the 2000-2012 California Cancer Registry. Data were linked to the OSHPD (California Office of Statewide Health Planning and Development) birth and discharge data sets. We included patients with cervical cancer who conceived at least 3 months after a fertility-sparing surgery, which included cervical conization or loop electrosurgical excision procedure. Those undergoing trachelectomy were excluded. The primary outcome was preterm birth. Secondary outcomes included growth restriction, neonatal morbidity, stillbirth, cesarean delivery, and severe maternal morbidity. We used propensity scores to match similar women from two groups in a 1:2 ratio of case group participants to control group participants: population individuals without cancer and individuals with cervical cancer (women who delivered before their cervical cancer diagnosis). Wald statistics and logistic regressions were used to evaluate outcomes. Of 4,087 patients with cervical cancer, 118 (2.9%) conceived after fertility-sparing surgery, and 107 met inclusion criteria and were matched to control group participants. Squamous cell carcinoma was the most common histology (63.2%), followed by adenocarcinoma (30.8%). Patients in the case group had higher odds of preterm birth before 37 weeks of gestation compared with both control groups (21.5% vs 9.3%, odds ratio [OR] 2.7, 95% CI 1.4-5.1; 21.5% vs 12.7%, OR 1.9, 95% CI 1.0-3.6), but not preterm birth before 32 weeks. Neonatal morbidity was more common among the patients in the case group relative to those in the cervical cancer control group (15.9% vs 6.9%, OR 2.5, 95% CI 1.2-5.5). There were no differences in rates of growth restriction, stillbirth, cesarean delivery, and maternal morbidity. In a population-based cohort, patients who conceived after surgery for cervical cancer had higher odds of preterm delivery compared with control groups.

Fertility-sparing surgery for patients with stage IC2 or IC3 epithelial ovarian carcinoma: any evidence of safety?

<h3>Objectives:</h3> For young patients with epithelial ovarian carcinoma (EOC), stage IC2 or IC3 disease is regarded as a relative contra-indication for fertility-sparing surgery (FSS) due to data suggesting a higher relapse rate compared to patients with stage IA or IC1 disease. The aim of the present study was to investigate the oncologic outcomes of patients with stage IC2/3 EOC who underwent FSS utilizing a large database and perform a systematic review of the literature. <h3>Methods:</h3> Patients aged ≤45 years without a history of another tumor diagnosed between 2004-2015 with EOC, who underwent surgical staging with lymphadenectomy and had tumor involving the ovarian surface (IC2), malignant ascites or positive cytology (IC3) were identified in the National Cancer Database. FSS group included patients who had preservation of the uterus and the contralateral ovary while radical surgery group included patients who had hysterectomy with bilateral salpingo-oophorectomy. Overall survival (OS) was compared following generation of Kaplan-Meier curves with the log-rank test while a Cox model was constructed to control for tumor histology, grade and substage. A systematic review of the literature (Medline and EMBASE databases) was performed and cumulative relapse rate among patients with IC2/3 disease who underwent FSS was calculated. <h3>Results:</h3> A total of 135 patients with stage IC2/3 disease who met the inclusion criteria were identified; 69 (51.1%) and 66 (48.9%) with stage IC2 and IC3 respectively. FSS was performed for 42 patients (31.1%). Patients who underwent FSS were younger (median 29 vs 41 years, p<0.001), and more likely to have non-serous tumors (83.3% vs 58.1%, p=0.006) and stage IC2 disease (66.7% vs 44.1%, p=0.017). Tumor grade (p=0.71), comorbidities (p=0.55) and chemotherapy administration (p=0.18) were comparable between the FSS and radical surgery groups. There was no difference in OS between the FSS and radical surgery groups, p=0.23; 5-year OS rates were 94% and 83.7% respectively. After controlling for tumor histology, and grade performance of FSS was not associated with worse survival (HR: 0.56, 95% CI: 0.19, 1.69). A systematic review identified 144 patients with EOC and stage IC2 or IC3 disease who underwent FSS. Cumulative relapse rate was 20.1% (n=29). A total of 12 (8.3%) deaths were reported, while 3 (2.1%) patients were alive with disease. Median time to recurrence was 19 months. Among patients who experienced a relapse, 10 had serous, 10 mucinous, 4 clear cell, and 4 endometrioid histology while the majority (18/28, 64.3%) had grade 1 or 2 tumors. Based on available data, relapse rate was 20.7% (12/58) and 14% (8/57) for patients with stage IC3 and IC2 disease respectively. <h3>Conclusions:</h3> In a large cohort of young patients with stage IC2/3 EOC, FSS was not associated with worse overall survival. However, based on a systematic review of literature approximately 1 in 5 patients experienced a relapse.

Oncological and reproductive outcomes of cystectomy compared with unilateral salpingo-oophorectomy as fertility-sparing surgery in patients with apparent early-stage pure immature ovarian teratomas

<h3>Objectives:</h3> To compare the oncological and reproductive outcomes of patients with apparent early-stage pure immature teratomas (IMTs) of the ovary treated with cystectomy or unilateral salpingo-oophorectomy (USO). <h3>Methods:</h3> We retrospectively reviewed the medical records of patients with apparent early-stage pure IMTs who received fertility-sparing surgery (FSS) between January 1984 and December 2019. FSS was defined as preservation of the uterus and at least one adnexa. Recurrence rates were compared between patients receiving cystectomy and USO. Reproductive outcomes and menstrual histories were assessed by telephone interview. <h3>Results:</h3> A total of 124 patients were included, of whom 41 underwent cystectomy and 83 underwent USO. After a median follow-up of 70.6 months (range: 6.2–410.6 months), eight patients suffered recurrences (3 in the cystectomy group and 5 in the USO group). The median times to recurrence were 5.1 and 5.0 months in the cystectomy and USO groups, respectively (P=0.764). All patients with recurrence were successfully salvaged by surgery, except for one death. Univariate analysis showed no difference in disease-free survival and overall survival between the groups (P=0.781, 0.155). Of the 111 patients contacted by telephone, 97 resumed menstruation following the surgery. Of the 31 patients desiring pregnancy, 26 achieved 28 successful pregnancies. USO (83.3%), like cystectomy (85.7%), resulted in excellent pregnancy rates. <h3>Conclusions:</h3> A USO is the standard treatment for women with early stage pure IMTs who want to preserve fertility. However, a cystectomy may be a suitable fertility-sparing therapy when a cystectomy is the only surgical option.

Pregnancy following fertility-sparing surgery for early-stage ovarian cancer is not associated with poor obstetric outcomes

<h3>Objectives:</h3> While ovarian cancer is most frequently diagnosed in postmenopausal women, 10% are diagnosed during reproductive years. As more women delay childbearing, the number of women who have yet to complete their family at the time of diagnosis will increase. Fertility-sparing surgery (FSS) is an important treatment option that can allow women to conceive in the future, though data for obstetric outcomes following FSS are conflicting. We sought to use population-based data to evaluate obstetric outcomes in patients with early-stage ovarian cancer. <h3>Methods:</h3> This is a population based retrospective study of women age 18-45 years with a history of stage IA and IC ovarian cancer reported to the California Cancer Registry (CCR) for the years 2000-2012. CCR data were linked to the 2000-2015 California Office of Statewide Health Planning and Development (OSPHD) birth and discharge datasets to establish a linked database with both oncologic characteristics and obstetric outcomes. Exposure status was defined as ovarian cancer patients who conceived at least 3 months after fertility-sparing surgery (FSS) and delivered after 23 weeks gestational age (GA). The primary outcome was preterm birth, and only the first pregnancy following cancer diagnosis was considered. Secondary outcomes included growth restriction, neonatal morbidity (in the first 30 days) and severe maternal morbidity (SMM) as defined by the CDC. Propensity score was used to match similar women in 2 groups in a 1:2 ratio (when possible) of cases to controls: group 1: Women who conceived at least 1 year prior to their ovarian cancer diagnosis; group 2: healthy controls. Wald statistics and logistic regression were used to evaluate outcomes. <h3>Results:</h3> Of the 1618 patients who were 18-45 years at time of ovarian cancer diagnosis, 36.8% (n=595) had a recorded pregnancy. Of those, 133 conceived following FSS and were primarily Hispanic (36.8%) followed by non-Hispanic White (31.6%) with a median age of 30 (26-34). Ovarian cancer patients who delivered during the study period were less likely to have epithelial histology (57.1% vs 78.3%, <i>P</i><<i>0.001</i>), and less likely to have received chemotherapy (24.1% vs 36.9% P=0.006) compared to those who did not. They were also less likely to have received chemotherapy (26.1% vs 37.0% P=0.017). Propensity score matching based on age, education, insurance status, race, year of diagnosis, income, year of delivery, parity, single vs multiple gestation, and maternal comorbidities (hypertension, gestational and pre-gestational diabetes, preeclampsia, abnormal placentation and chronic renal disease) yielded 156 group 1 controls and 266 group 2 controls. Undergoing ovarian cancer surgery at least 3 months prior to conception was not associated with premature delivery before 37 weeks (OR 1.17, 95% CI 0.60-2.30), delivering a growth restricted infant (<10th %ile OR 1.08 95% CI 0.56-2.10; 5th %ile OR 0.85 95% CI 0.32-2.27), cesarean delivery (OR 1.32, 95% CI 0.86-2.03), severe maternal morbidity (OR 2.03, 95% CI 0.50-8.25), or neonatal morbidity (OR 0.48 95% CI 0.19-1.20). <h3>Conclusions:</h3> In a population-based cohort, patients who conceived at least 3 months following surgery for early-stage ovarian cancer did not have an increased risk of poor obstetric outcomes. These data may aid in shared decision making about FSS for patients with early-stage ovarian cancer.

Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Ovarian Cancer.

To evaluate the outcomes of the first pregnancy after fertility-sparing surgery in patients treated for early-stage ovarian cancer. We performed a retrospective study of women aged 18-45 years with a history of stage IA or IC ovarian cancer reported to the California Cancer Registry for the years 2000-2012. These data were linked to the 2000-2012 California Office of Statewide Health Planning and Development birth and discharge data sets to ascertain oncologic characteristics and obstetric outcomes. We included in the case group ovarian cancer patients who conceived at least 3 months after fertility-sparing surgery. The primary outcome was preterm birth, and only the first pregnancy after cancer diagnosis was considered. Secondary outcomes included small-for-gestational-age (SGA) neonates, neonatal morbidity (respiratory support within 72 hours after birth, hypoxic-ischemic encephalopathy, seizures, infection, meconium aspiration syndrome, birth trauma, and intracranial or subgaleal hemorrhage), and severe maternal morbidity as defined by the Centers for Disease Control and Prevention. Propensity scores were used to match women in a 1:2 ratio for the case group and the control group. Wald statistics and logistic regressions were used to evaluate outcomes. A total of 153 patients who conceived after fertility-sparing surgery were matched to 306 women in a control group. Histologic types included epithelial (55%), germ-cell (37%), and sex-cord stromal (7%). Treatment for ovarian cancer was not associated with preterm birth before 37 weeks of gestation (13.7% vs 11.4%; odds ratio [OR] 1.23, 95% CI 0.69-2.20), SGA neonates (birth weight less than the 10th percentile: 11.8% vs 12.7%; OR 0.91, 95% CI 0.50-1.66), severe maternal morbidity (2.6% vs 1.3%; OR 2.03, 95% CI 0.50-8.25), or neonatal morbidity (both 5.9% OR 1.00, 95% CI 0.44-2.28). Patients who conceived at least 3 months after surgery for early-stage ovarian cancer did not have an increased risk of adverse obstetric outcomes.

Oncological and Reproductive Outcomes of Cystectomy Compared with Unilateral Salpingo-Oophorectomy as Fertility-Sparing Surgery in Patients with Apparent Early Stage Pure Immature Ovarian Teratomas.

To compare the oncological and reproductive outcomes of patients with apparent early stage pure ovarian immature teratomas (IMTs) treated with unilateral salpingo-oophorectomy (USO) or cystectomy. We retrospectively reviewed the medical records of patients with apparent early stage pure ovarian IMTs who received fertility-sparing surgery (FSS) between 1984 and 2019. FSS was defined as preservation of the uterus and at least one adnexa. Recurrence rates were compared between patients receiving USO and cystectomy. Reproductive outcomes and menstrual histories were assessed by telephone interview. A total of 124 patients were included, of whom 83 underwent USO and 41 underwent cystectomy. After a median follow-up of 70.6 months (range: 6.2-410.6 months), eight patients suffered recurrences (5 in the USO group and 3 in the cystectomy group). The median times to recurrence were 5.0 and 5.1 months in the USO and cystectomy groups, respectively (P=0.764). All patients with recurrence were successfully salvaged by surgery, except for one death. Univariate analysis showed no difference in disease-free survival and overall survival between the groups (P=0.781, 0.155). Of the 111 patients contacted by telephone, 97 resumed menstruation following the surgery. Of the 31 patients desiring pregnancy, 26 achieved 28 pregnancies. USO (83.3%), like cystectomy (85.7%), resulted in excellent pregnancy rates. A USO is the standard treatment for women with early stage pure IMTs who want to preserve fertility. However, a cystectomy with adjuvant chemotherapy may be a suitable fertility-sparing therapy when a cystectomy is the only surgical option.

Oncologic and reproductive outcomes of borderline ovarian tumors in Indian population

Borderline ovarian tumor (BOT) is characterized by atypical epithelial proliferation without stromal invasion and majority are diagnosed at early stages and in women of reproductive age group. A retrospective review of medical records of patients diagnosed with BOT and on regular follow up at All India Institute of Medical Sciences New Delhi, during a five-year study period from March 2014 to March 2019 was performed. Surgical treatment was classified as radical, fertility sparing surgery (FSS) or cystectomy. Surgical staging was defined as complete, partial or unstaged. Median age of seventy-five women was 32 years. Follow up period ranged from 22 to 61 months (median 36 m). Radical surgery was done in 34 (45.3%), FSS in 32 (42.6%) and cystectomy in 9 (12.0%) women. Complete surgical staging was performed in 22 (29.3%), partial staging in 23 (30.6%) and 30 (40%) were unstaged. During the follow up period, 98.7% patients were alive and 90.7% were free of recurrence. Median time to recurrence was 35 months. Recurrence rate was 33.3% in cystectomy vs 6.2% in oophorectomy (p = 0.03). All seven recurrences were in unstaged (six) or partially staged patient (one). Six recurrences in ovary were salvaged by surgery and recurrent disease was of borderline histology. Spontaneous conception and live birth rate was 42.1%. FSS is a safe procedure and should be considered in a young patient with early stage disease and desirous of future fertility. Spontaneous conception and live birth rates after fertility sparing surgery in patients with BOT are modest.

Neo-adjuvant chemotherapy in fertility-sparing cervical cancer treatment

The current review provides a literature overview of studies assessing the oncological and fertility outcomes of treatment with neo-adjuvant chemotherapy followed by fertility-sparing surgery in patients with cervical cancer >2cm. Six cohort studies were included showing severe heterogeneity regarding patient selection, chemotherapy regimen, and surgical approach. In total, 111 patients were studied, with overall favorable characteristics. Patients were on average 29 years old, had a tumor of 36mm, no lymph node metastasis, and response to chemotherapy. In approximately 5-year follow-up, the recurrence rate was 13% (0%-21%) and overall death rate 2.7% (0%-10%). Three patients were alive with recurrent disease (2.7% and 0%-11%). Of the 111 patients, 90 underwent successful fertility-sparing treatment (83%). Roughly one-third conceived and one-fourth had a healthy live-born child. More research is essential to determine proper selection criteria for fertility-sparing treatment of cervical cancer >2cm and the optimal treatment management.

Fertility-sparing Surgery for Patients with Cervical, Endometrial, and Ovarian Cancers

Nearly 10% of the 1.3 million women living with a gynecologic cancer are aged <50 years. For these women, although their cancer treatment can be lifesaving, it's also life-altering because traditional surgical procedures can cause infertility and, in many cases, induce surgical menopause. For appropriately selected patients, fertility-sparing options can reduce the reproductive impact of lifesaving cancer treatments. This review will highlight existing recommendations as well as innovative research for fertility-sparing treatment in the 3 major gynecologic cancers. For early-stage cervical cancers, fertility-sparing surgeries include cold knife conization, simple hysterectomy with ovarian preservation, or radical trachelectomy with placement of a permanent cerclage. In locally advanced cervical cancer, ovarian transposition before radiation therapy can help preserve ovarian function. For endometrial cancers, fertility-sparing treatment includes progestin therapy with endometrial sampling every 3 to 6 months. After cancer regression, progestin therapy can be halted to allow attempts to conceive. Hysterectomy with ovarian preservation can also be considered, allowing for fertility using assisted reproductive technology and a gestational carrier. For ovarian cancers, fertility-sparing surgery includes unilateral salpingo-oophorectomy or bilateral salpingo-oophorectomy (with lymphadenectomy and staging depending on tumor histology). With higher-risk histology or higher early-stage disease, adjuvant chemotherapy is recommended-however, this carries a 3% to 10% risk of ovarian failure. Use of oocyte or embryo cryopreservation in patients with early-stage ovarian malignancy remains an area of ongoing research. Overall, fertility-sparing management of gynecologic cancers is associated with acceptable rates of progression-free survival and overall survival and is less life-altering than more radical surgical approaches.

Oncological and obstetrical outcomes after neo-adjuvant chemotherapy followed by fertility-sparing surgery in patients with cervical cancer ≥2 cm

ObjectiveThere is significant debate between up-front radical trachelectomy versus neo-adjuvant chemotherapy before fertility-sparing surgery in patients with tumors ≥2 cm. The aim of this study was to report on the...

Fertility sparing surgery for patients with FIGO stage I clear cell ovarian carcinoma: a database analysis and systematic review of the literature

ObjectiveFertility sparing surgery for patients with early stage ovarian clear cell carcinoma is controversial. We aimed to investigate the impact of fertility sparing surgery on the oncologic outcomes of young...

Robotic uterine transposition for a cervical cancer patient with pelvic micrometastases after conization and pelvic lymphadenectomy

Uterine transposition was first reported[1][1] in 2017 as a possible fertility sparing surgery for patients with non-gynecologic cancer who require pelvic radiotherapy. In 2018, it was reported in a patient...