Outcomes of fertility-sparing surgery
Issue 19: 17 Sep 2007
Source: European Journal of Obstetrics & Gynecology and Reproductive Biology 2007;134:110-4
A long-term outcome study has shown that fertility-sparing surgery can be successful and safe in young women with ovarian borderline tumors or early invasive disease.
Researchers from University Hospital Lund, in Sweden, followed up all 23 women under 45 years of age who were diagnosed with an ovarian borderline tumor or early invasive ovarian cancer who underwent fertility-sparing surgery (removal only of the ovarian lesion) at the center between 1988 and 2002.
Of the 23 patients, 12 had borderline stage 1a tumors in one ovary and 11 had invasive stage 1a-c epithelial ovarian cancer (10 had stage 1a tumors, and one had a stage 1c tumor; nine tumors was classified histologically as well-differentiated, one was moderately differentiated, and the stage 1c tumor was poorly differentiated). The mean age of the patients at surgery was 30.3 years (range 18-43 years).
Postoperatively, all of the patients were examined clinically and with transvaginal ultrasonography. This was performed twice during the first year, then once every year.
In the current issue of the European Journal of Obstetrics & Gynecology and Reproductive Biology, the researchers describe the outcomes recorded over a median of 92 months of follow-up (range 11-185 months). They report that there were no relapses in any of the 22 women with stage 1a tumors.
The woman with stage 1c cancer was approximately at the end of the first trimester of pregnancy at the time of the primary unilateral oophorectomy, and continued with the pregnancy afterwards. On cesarean section at 37 weeks’ gestation, the ovarian cancer was found to have disseminated. The patient received chemotherapy, but died within one year.
Overall, 15 of the 23 patients became pregnant at least once during follow-up, and had a total of 30 children. However, only six of these women had so far accepted the recommendation of prophylactic removal of the remaining ovary and hysterectomy after completing child-bearing, to prevent recurrence of the cancer.
Pregnancy “not only possible but probable”
Discussing their findings, the researchers write that the high proportion of women who had children “indicates that successful reproduction in patients with stage 1a ovarian cancer or borderline tumors treated by conservative surgery is not only possible but probable.”
They conclude: “This study and other recent investigations have shown that patients with stage 1a epithelial ovarian cancer treated with fertility-sparing surgery have an excellent prognosis.” The researchers add that the findings indicate that “young women with stage 1a epithelial ovarian cancer and borderline tumors do not have to give up their fertility in order to receive successful and safe treatment of their disease.”
http://www.orgyn.com/en/webzine/2007...93433564467593
Outcomes of fertility-sparing surgery 
