Fertility-Sparing Surgery for Ovarian Cancer

Abstract

(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.

Fertility Preserving Surgery Outcomes for Ovarian Malignancy: Data from a Tertiary Cancer Centre in Central London

“…While this number may initially seem low, it is on the higher side compared to other studies which quote rates of 16–50% [ 18 ]. There was an overall successful pregnancy rate of 59%, which is comparable to a number of other studies which quote ranges of 54–67% [ 6 , 19 ]. The IVF rate of (12%) was comparable to other studies, but markedly higher than the general population [ 20 , 21 ].…”

“…The recurrence rate in this study was 22%, which is slightly higher than other studies which quote figures between 13 and 15%, [ 6 , 7 , 26 ] This may be explained by the fact that this study included patients over the age of 40 and women with higher grade tumours. The finding that death was associated with a disease stage greater than 1A supports large systematic reviews [ 10 ].…”

“…The mean age at diagnosis in this study was 30 years. This is half the average age at diagnosis for ovarian cancer [ 6 ]. This is due to the fact that FSS is only offered to patients of child-bearing age and usually accepted by women who have not completed their family.…”

“…One of the challenges in counselling patients considering FSS is the fact that most studies to date mix the various histological subtypes of ovarian cancers as well as borderline ovarian tumours (BOT). Regardless of this, the evidence to date suggests that FSS in carefully selected patients yields a comparable prognosis to radical surgery, and live birth rates of up to 67% are expected [ 6 ]. A recent systematic review by Canlorbe and colleagues concluded that FSS could safely be offered to women with epithelial and non-epithelial ovarian cancers < 1C3 [ 6 ].…”

“…Regardless of this, the evidence to date suggests that FSS in carefully selected patients yields a comparable prognosis to radical surgery, and live birth rates of up to 67% are expected [ 6 ]. A recent systematic review by Canlorbe and colleagues concluded that FSS could safely be offered to women with epithelial and non-epithelial ovarian cancers < 1C3 [ 6 ]. Additionally, a prospective study of 105 women with epithelial ovarian cancer (EOC) undergoing FSS demonstrated no difference in survival compared to women who underwent radical surgery for tumours staged < 2A [ 7 ].…”