Fertility-sparing surgery and reproductive-outcomes in patients with borderline ovarian tumors

Plett, Helmut; Harter, Philipp; Ataseven, Beyhan; Heitz, Florian; Prader, Sonia; Schneider, Stephanie; Heikaus, Sebastian; Fisseler‐Eckhoff, Annette; Kommoss, Friedrich; Lax, Sigurd; Staebler, Annette; Traut, Alexander; Bois, Andreas du

doi:10.1016/j.ygyno.2020.02.007

Cited by 34 publications

(39 citation statements)

References 33 publications

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“…The observed pregnancy rates after FSS for patients with BOT and a desire for pregnancy lie between 32 and 88% ( Table 1 ) [ 12 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Three main factors impact fertility rates: the type of FSS performed, the patient’s age, and the histologic subtype of the tumor.…”

Section: Borderline Ovarian Tumorsmentioning

confidence: 99%

Fertility-Sparing Surgery for Ovarian Cancer

Canlorbe

Chabbert-Buffet

Uzan

2021

JCM

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(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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Section: Borderline Ovarian Tumorsmentioning

confidence: 99%

Fertility-Sparing Surgery for Ovarian Cancer

Canlorbe

Chabbert-Buffet

Uzan

2021

JCM

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“…18,19 In the meantime, there is consensus on the recommendation of caution regarding conservative surgery for hormone-sensitive ovarian tumors, as well as for high-risk serous borderline tumors 20 and those in advanced stages. 3 To date, the safety of fertility sparing approaches to different ovarian tumors in childbearing age patients really seems to be realistic. The recent meta-analysis of eight observational studies, comparing 2,223 women undergoing conservative surgery with 5,809 undergoing radical surgery did not find differences in overall survival and disease-free survival with either surgical techniques for stage 1 epithelial ovarian cancer.…”

Section: Discussionmentioning

confidence: 99%

Ex vivo Retrieval of Mature Oocytes for Fertility Preservation in a Patient with Bilateral Borderline Ovarian Tumor

Carvalho

Cintra

Franceschi

et al. 2021

Rev Bras Ginecol Obstet

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We report a case of ultrasound-guided ex vivo oocyte retrieval for fertility preservation in a woman with bilateral borderline ovarian tumor, for whom conventional transvaginal oocyte retrieval was deemed unsafe because of the increased risk of malignant cell spillage. Ovarian stimulation with gonadotropins was performed. Surgery was scheduled according to the ovarian response to exogenous gonadotropic stimulation; oophorectomized specimens were obtained by laparoscopy, and oocyte retrieval was performed ∼ 37 hours after the ovulatory trigger. The sum of 20 ovarian follicles were aspirated, and 16 oocytes were obtained. We performed vitrification of 12 metaphase II oocytes and 3 oocytes matured in vitro. Our result emphasizes the viability of ex vivo mature oocyte retrieval after controlled ovarian stimulation for those with high risk of malignant dissemination by conventional approach.

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“…The diagnosis of borderline tumors can be incidental during surgical intervention for benign ovarian tumors, and experience and training in gynecologiconcology is required for staging during the surgical treatment. Reproductive results are higher in borderline tumors than in early-stage EOC; Chevrot et al and Plett et al reported pregnancy rates of 62% in patients with borderline tumors and 85% in patients with early-stage EOC, respectively (30,31).…”

Section: Borderline Tumorsmentioning

confidence: 98%

Fertility-sparing treatment for epithelial ovarian cancer: a literature review

et al. 2020

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Epithelial ovarian cancer is more common in postmenopausal women, with a mean age at diagnosis of 65 years; however, it has been documented that 3% to 17% of epithelial ovarian cancer cases are diagnosed in women younger than 40 years, with an overall survival of up to 90% when diagnosed in early-stage disease. The development of fertility-sparing approaches represents one of the most significant advances in the gynecologic oncology field. These approaches can have satisfactory outcomes on fertility with excellent oncological results in premenopausal women with early-stage epithelial ovarian cancer and the desire to preserve fertility. Because of the low occurrence of this specific population, randomized trials have not been performed. However, several retrospective series suggest that in certain cases, fertility-sparing surgery is safe, with low rates of recurrence and favorable reproductive outcomes in accordance to the new techniques in reproductive biology; therefore, fertility-sparing approaches must be discussed with young female patients with epithelial ovarian cancer or in patients that desire to preserve fertility or to maintain ovarian function and to improve quality of life in this particular group of individuals. In this review, we present the published evidence, including oncologic and reproductive results, as well as fertility-sparing surgical options, in the field in the last 10 years.

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Fertility-sparing surgery and reproductive-outcomes in patients with borderline ovarian tumors

Cited by 34 publications

References 33 publications

Fertility-Sparing Surgery for Ovarian Cancer

Fertility-Sparing Surgery for Ovarian Cancer

Ex vivo Retrieval of Mature Oocytes for Fertility Preservation in a Patient with Bilateral Borderline Ovarian Tumor

Fertility-sparing treatment for epithelial ovarian cancer: a literature review

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