Oncologic and fertility impact of surgical approach for borderline ovarian tumours treated with fertility sparing surgery

Marchette, Martina Delle; Ceppi, Lorenzo; Andreano, Anita; Bonazzi, Cristina; Buda, Alessandro; Grassi, Tommaso; Giuliani, Daniela; Sina, Federica; Lamanna, Maria; Bianchi, Tommaso; Lissoni, Andrea Alberto; Landoni, Fabio; Valsecchi, Maria Grazia; Fruscio, Robert

doi:10.1016/j.ejca.2019.01.021

Cited by 57 publications

(54 citation statements)

References 24 publications

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“…Fertility-sparing surgery effectively preserves fertility and allows spontaneous pregnancies. The cumulative spontaneous pregnancy rate is 50-60% after conservative surgery [6,11]. Nevertheless, the recurrence rate is higher after this conservative strategy, and is evaluated at 20-30% [12,13].…”

Section: Discussionmentioning

confidence: 99%

“…In a cohort study by Chevrot et al with 52 women of childbearing age, the pregnancy rate after conservative BOT treatment was 63%, but 26% of women required postoperative assisted reproductive medicine to conceive [18]. In a retrospective cohort study of 535 women who underwent conservative surgery, Delle Marchette et al showed that each ovarian surgery reduced the probability of achieving a spontaneous pregnancy by 40% [11].…”

Section: Discussionmentioning

confidence: 99%

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Fertility preservation after fertility-sparing surgery in women with borderline ovarian tumours

Khiat¹,

Provansal

Bottin³

et al. 2020

European Journal of Obstetrics & Gynecology and Reproductiv

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To present a case series of women with borderline ovarian tumours (BOTs) who underwent oocyte vitrification in addition to fertility-sparing surgery. Study design: Observational study of all women referred to a French fertility preservation unit between 2015 and 2019 for counselling regarding a fertility preservation (FP) strategy after BOT fertility-sparing surgery. All eligible women underwent one or more cycles of controlled ovarian stimulation (COS) using an antagonist protocol, followed by oocyte retrieval. Metaphase II (MII) oocytes were vitrified. Results: Twenty-five women with BOTs were referred during the study period. Among them, 11 women underwent at least one cycle of COS. One hundred and seven MII oocytes were vitrified. The mean number of vitrified MII oocytes per woman was 9.7 (standard deviation 5.2). Five live births were reported during follow-up of four women with vitrified oocytes: three spontaneous pregnancies, one invitro fertilization cycle with fresh embryo transfer, and one live birth after return of vitrified oocytes. Conclusion: Conservative surgery for BOTs offers a high spontaneous pregnancy rate but has a higher risk of relapse than radical treatment. Furthermore, women who undergo conservative BOT surgery have a higher risk of surgery-induced premature ovarian failure. Oocyte cryopreservation after COS appears to be an effective technique after the conservative management of BOTs in women of reproductive age. Although the available short-term data are reassuring, further long-term studies evaluating the safety and cost-effectiveness of this systematic FP strategy after BOT fertility-sparing surgery are required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fertility preservation after fertility-sparing surgery in women with borderline ovarian tumours

Khiat¹,

Provansal

Bottin³

et al. 2020

European Journal of Obstetrics & Gynecology and Reproductiv

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“…Several series have shown that laparoscopic surgery for fertility-sparing procedures in malignant and borderline ovarian tumors is feasible and is associated with similar oncological outcomes compared with traditional open surgery and demolitive procedures. [21][22][23][24][25] In this case of a 15year-old patient, we obviously proposed fertility sparing with preservation of the affected ovary, as indicated by the newest guidelines by National Comprehensive Cancer Network on this specific issue. 22 We discussed for long in our multidisciplinary team about whether to perform or not monolateral adnexectomy in this case but in the end, we decided to comply with the available recommendations.…”

Section: Discussionmentioning

confidence: 99%

The Case of a Serous Borderline Ovarian Tumor in a 15-Year Old Pregnant Adolescent: Sonographic Characteristics and Surgical Management

et al. 2020

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Objective This study aimed to describe a rare case of a serous borderline ovarian tumor (BOT) diagnosed during pregnancy in a 15-year old adolescent. Results The suspect of BOT was raised at a transvaginal ultrasound scan in early first trimester (at 5 weeks of amenorrhea), due to the presence of a moderately vascularized irregular papilla in the context of a unilocular low-level right ovarian cyst. The patient and her parents required termination of pregnancy, irrespective of the diagnosis of an ovarian lesion. After termination of pregnancy, the patient underwent laparoscopic enucleation of the ovarian mass, omentectomy, and peritoneal biopsies. No intra-abdominal spillage of the ovarian mass occurred, and the surgical specimens were put in an endobag and extracted transvaginally. Final pathological examination confirmed the diagnosis of a serous borderline ovarian tumor. The patient of free of disease after 8 months of follow-up. Conclusion Although rare, borderline ovarian tumors can be diagnosed in an adolescent during pregnancy. The combination of specific sonographic assessment and minimally invasive conservative surgery appears as a very effective approach in this type of patient. Key Points

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“…However, following on from the study by Trillsch et al., there is significant evidence to suggest that 5‐year overall survival following fertility‐sparing surgery (unilateral salpingo‐oophorectomy or ovarian cystectomy) equates to debulking surgery [25, 26]. It is therefore safe for women to conceive during interval monitoring of disease [27]. Fertility‐sparing surgery is considered in women with early stage disease, non‐invasive implants and in those with a desire to conceive.…”

Section: Fertility‐sparing Surgical Techniquesmentioning

confidence: 99%

Anaesthetic considerations for fertility‐sparing surgery and uterine transplantation

et al. 2021

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Summary A number of benign and malignant gynaecological conditions can cause infertility. Advancements in assisted reproductive technologies have facilitated the rapidly evolving subspecialty of fertility preservation. Regardless of clinical indication, women now have the reproductive autonomy to make fully informed decisions regarding their future fertility. In particular, there has been an increasing interest and demand among patients and healthcare professionals for fertility‐sparing surgery. Gynaecologists find themselves continually adapting surgical techniques and introducing novel procedures to facilitate this rapidly emerging field and anaesthetists need to manage the consequent physiological demands intra‐operatively. Not only is it important to understand the surgical procedures now undertaken, but also the intra‐operative management in an ever evolving field. This article reviews the methods of fertility‐sparing surgery and also describes important anaesthetic challenges including peri‐operative care for women undergoing complex fertility‐sparing surgeries such as uterus transplantation.

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Oncologic and fertility impact of surgical approach for borderline ovarian tumours treated with fertility sparing surgery

Cited by 57 publications

References 24 publications

Fertility preservation after fertility-sparing surgery in women with borderline ovarian tumours

Fertility preservation after fertility-sparing surgery in women with borderline ovarian tumours

The Case of a Serous Borderline Ovarian Tumor in a 15-Year Old Pregnant Adolescent: Sonographic Characteristics and Surgical Management

Anaesthetic considerations for fertility‐sparing surgery and uterine transplantation

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