Fertility-Sparing Surgery for Ovarian Cancer

(1) Background: although most patients with epithelial ovarian cancer (EOC) undergo radical surgery, patients with early-stage disease, borderline ovarian tumor (BOT) or a non-epithelial tumor could be offered fertility-sparing surgery (FSS) depending on histologic subtypes and prognostic factors. (2) Methods: we conducted a systematic review to assess the safety and fertility outcomes of FSS in the treatment of ovarian cancer. We queried the MEDLINE, PubMed, Cochrane Library, and Cochrane (“Cochrane Reviews”) databases for articles published in English or French between 1985 and 15 January 2021. (3) Results: for patients with BOT, FSS should be offered to young women with a desire to conceive, even if peritoneal implants are discovered at the time of initial surgery. Women with mucinous BOT should undergo initial unilateral salpingo-oophorectomy, whereas cystectomy is an acceptable option for women with serous BOT. Assisted reproductive technology (ART) can be initiated in patients with stage I BOT if infertility persists after surgery. For patients with EOC, FSS should only be considered after staging for women with stage IA grade 1 (and probably 2, or low-grade in the current classification) serous, mucinous or endometrioid tumors. FSS could also be offered to patients with stage IC grade 1 (or low-grade) disease. For women with serous, mucinous or endometrioid high-grade stage IA or low-grade stage IC1 or IC2 EOC, bilateral salpingo-oophorectomy and uterine conservation could be offered to allow pregnancy by egg donation. Finally, FSS has a large role to play in patients with non- epithelial ovarian cancer, and particularly women with malignant ovarian germ cell tumors.

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Pregnancy and oncologic outcomes of early stage low grade epithelial ovarian cancer after fertility sparing surgery: a retrospective study in one tertiary hospital of China

Journal of Ovarian Research ◽

10.1186/s13048-019-0520-6 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 8

Author(s):

Jie Yin ◽

Yongxue Wang ◽

Ying Shan ◽

Yan Li ◽

Ying Jin ◽

...

Keyword(s):

Ovarian Cancer ◽

Retrospective Study ◽

Epithelial Ovarian Cancer ◽

Early Stage ◽

Tertiary Hospital ◽

Oncologic Outcomes ◽

Low Grade ◽

Fertility Sparing Surgery ◽

Fertility Sparing

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Outcomes of Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer: A Proposal for Patient Selection

Journal of Clinical Oncology ◽

10.1200/jco.2009.24.8617 ◽

2010 ◽

Vol 28 (10) ◽

pp. 1727-1732 ◽

Cited By ~ 119

Author(s):

Toyomi Satoh ◽

Masayuki Hatae ◽

Yoh Watanabe ◽

Nobuo Yaegashi ◽

Osamu Ishiko ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Clear Cell ◽

Stage I ◽

Healthy Children ◽

Favorable Histology ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Stage Ia ◽

Grade 3

Purpose The objective of this study was to assess clinical outcomes and fertility in patients treated conservatively for unilateral stage I invasive epithelial ovarian cancer (EOC). Patients and Methods A multi-institutional retrospective investigation was undertaken to identify patients with unilateral stage I EOC treated with fertility-sparing surgery. Favorable histology was defined as grade 1 or grade 2 adenocarcinoma, excluding clear cell histology. Results A total of 211 patients (stage IA, n = 126; stage IC, n = 85) were identified from 30 institutions. Median duration of follow-up was 78 months. Five-year overall survival and recurrence-free survival were 100% and 97.8% for stage IA and favorable histology (n = 108), 100% and 100% for stage IA and clear cell histology (n = 15), 100% and 33.3% for stage IA and grade 3 (n = 3), 96.9% and 92.1% for stage IC and favorable histology (n = 67), 93.3% and 66.0% for stage IC and clear cell histology (n = 15), and 66.7% and 66.7% for stage IC and grade 3 (n = 3). Forty-five (53.6%) of 84 patients who were nulliparous at fertility-sparing surgery and married at the time of investigation gave birth to 56 healthy children. Conclusion Our data confirm that fertility-sparing surgery is a safe treatment for stage IA patients with favorable histology and suggest that stage IA patients with clear cell histology and stage IC patients with favorable histology can be candidates for fertility-sparing surgery followed by adjuvant chemotherapy.

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Methods and conditions of fertility preservation in early-stage ovarian tumors

Orvosi Hetilap ◽

10.1556/oh.2013.29581 ◽

2013 ◽

Vol 154 (14) ◽

pp. 523-530

Author(s):

Erzsébet Szatmári ◽

Szabolcs Máté ◽

Norbert Sipos ◽

András Szánthó ◽

Mihály Silhavy ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Fertility Preservation ◽

Early Stage ◽

Ovarian Tumors ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Stage Ia ◽

Grade 3

The aim of this study is to review the literature of fertility-sparing techniques and their safety in early-stage malignant ovarian tumors, especially in epithelial ovarian cancer. Fertility preservation is widely accepted in early-stage borderline, germ cell and sex cord-stromal tumors. Based on data from retrospective studies, fertility-sparing surgery in epithelial ovarian cancer can be recommended in stage IA, grade 1–2 and favorable hystologic type ovarian cancer. Above stage IA, or in grade 3, or in clear-cell tumors decision making process about fertility-sparing surgery should be individual. Correct surgical staging is mandatory and oncologic safety should be primary. In the group of carefully selected patients oncological outcomes are identical to those of radical surgery. Spontaneous pregnancy rates vary, but they are generally high. Adequate counseling with patients, detailed documentation and careful follow-up is of outstanding importance. In order to improve the quality of fertility preservation techniques, establishment of treatment centers is recommended. Orv. Hetil., 2013, 154, 523–530.

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Fertility preservation in women with early ovarian cancer

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2020-0026 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Daniel Necula ◽

Daria Istrate ◽

Jérôme Mathis

Keyword(s):

Ovarian Cancer ◽

Fertility Preservation ◽

Low Grade ◽

Term Survival ◽

Organizational Issues ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Early Ovarian Cancer ◽

Reproductive Techniques

AbstractFertility preservation is an important option to consider for young women with low-grade early ovarian cancer. Fertility-sparing surgery (“FSS”) permits the conservation of the uterus and one of the ovaries. This technique is considered safe for stages IA G1, G2 and probably safe for IC G1 epithelial and non-epithelial ovarian cancers. There are still uncertainties and FSS is not fully accepted for stage IC G1, G2 and clear cell carcinoma. The difficulty in choosing the best option lies in the fact that there is a lack of prospective randomized studies, due to ethical and organizational issues. Retrospective studies and reviews showed reassuring results for FSS in terms of relapse and long term survival. The spontaneous pregnancy rate seems to decrease after FSS, but chemotherapy does not seem to have an impact on fertility rates. Compared with the general population, assisted reproductive techniques are considered safe and with similar fertility results.

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Outcome of Reproductive Age Women With Stage IA or IC Invasive Epithelial Ovarian Cancer Treated With Fertility-Sparing Therapy

Obstetrical & Gynecological Survey ◽

10.1097/01.ogx.0000058684.18516.cf ◽

2003 ◽

Vol 58 (4) ◽

pp. 254-255

Author(s):

Jeanne M. Schilder ◽

Amy M. Thompson ◽

Paul D. DePriest ◽

Frederick R. Ueland ◽

Michael L. Cibull ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Reproductive Age ◽

Reproductive Age Women ◽

Fertility Sparing ◽

Stage Ia ◽

Invasive Epithelial Ovarian Cancer

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Fertility-sparing surgery in epithelial ovarian cancer: a systematic review of oncological issues

Annals of Oncology ◽

10.1093/annonc/mdw311 ◽

2016 ◽

Vol 27 (11) ◽

pp. 1994-2004 ◽

Cited By ~ 34

Author(s):

E. Bentivegna ◽

S. Gouy ◽

A. Maulard ◽

P. Pautier ◽

A. Leary ◽

...

Keyword(s):

Systematic Review ◽

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Fertility Sparing Surgery ◽

Fertility Sparing

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Comparative study of epithelial ovarian cancer with or without fertility-sparing surgery in Chinese patients

Gynecologic Oncology ◽

10.1016/j.ygyno.2017.03.413 ◽

2017 ◽

Vol 145 ◽

pp. 182

Author(s):

X. Jiang ◽

J.X. Yang ◽

D.Y. Cao ◽

Y. You ◽

K. Shen

Keyword(s):

Ovarian Cancer ◽

Comparative Study ◽

Epithelial Ovarian Cancer ◽

Chinese Patients ◽

Fertility Sparing Surgery ◽

Fertility Sparing

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Non-Epithelial Ovarian Cancer; NCI Study

Tumori Journal ◽

10.1177/0300891620914127 ◽

2020 ◽

Vol 106 (1_suppl) ◽

pp. 7-7

Author(s):

Ashraf Sobhy ◽

Mohammed Gamil ◽

Omar Youssef ◽

Ali Hassan Mebed

Keyword(s):

Ovarian Cancer ◽

Germ Cell ◽

Epithelial Ovarian Cancer ◽

Germ Cell Tumors ◽

Disease Stage ◽

Early Stage Disease ◽

Stromal Tumors ◽

Ovarian Cancers ◽

Malignant Germ Cell Tumors ◽

Sex Cord Stromal Tumors

Background: Non-epithelial cancers of the ovary are uncommon. They include malignancies of germ cell origin, sex cord-stromal cell origin, metastatic carcinomas to the ovary, and a variety of extremely rare ovarian cancers, such as sarcomas and lipoid cell tumors. Nonepithelial malignancies account for about 10% of all ovarian cancers. Objective: To review the management of Non-epithelial ovarian cancer in the NCI Cairo university during a period of 5 years (2005 till 2010). Material and Methods: Retrospective study including 114 patients who were diagnosed and treated with Non-epithelial ovarian cancer (2005 to 2010). Data were collected from the biostatistics and cancer epidemiology department. Results: Out of 114 patients; 25(21.9%) were benign and 25 (21.9%) were borderline malignant; 55 (48.2%) were malignant and 9 (7.89%) of them were unpredicted biologic behavior; the median age of the study population was 49.7 years (range 14_83years). Panhysterectomy was done in 77(67.5%) of the patients; ovariectomy and debulking were done in 22(19.3%; salpingooophorectomy was done in 10(8.8%) 0f patients and cystectomy was done in 3(2.6%) and 2 cases underwent biopsy. Conclusion: Sex cord-stromal tumors and malignant germ cell tumors are the most common nonepithelial ovarian cancers. These tumors often, but not always, present with the sequelae of overproduction of either androgens or estrogens. It is important to diagnose these masses early, as overall prognosis is typically very good for early stage disease in all histological subtypes. Both sex cord-stromal tumors and malignant germ cell tumors of the ovary are treated with initial surgical resection. Fertility sparing surgery can be considered for both sex cord-stromal and malignant germ cell tumors of the ovary. Depending on the pathological diagnosis and disease stage, postoperative management consists of either expectant management or adjuvant chemotherapy. It is recommended that all patients with nonepithelial ovarian cancer be monitored for evidence of disease recurrence on a standardized schedule.

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