Long-term safety of fertility sparing surgery in early stage ovarian cancer: Comparison to standard radical surgical procedures
Introduction
Ovarian cancer represents the primary cause of death among gynecological malignancies and it is projected that more than 14,000 American women will die due to ovarian cancer in 2014 [1]. Traditionally, standard treatments of ovarian cancer lead to permanent sterility, since the extirpation of the uterus and the adnexal structures is considered mandatory.
Although the majority of cases occur in post-menopausal women, it is estimated that about 3–14% of invasive ovarian cancer is diagnosed in women aged less than 40 years old [2], [3]. These patients are in some cases identified at early stage of disease and could potentially receive a conservative surgical treatment, with the preservation of the uterus and the contra-lateral ovary. Fertility and hormonal preservation is considered as one of the most important quality of life (QoL) indicators among pre-menopausal ovarian cancer patients [4]. However, generally, surgeons are reluctant to perform a conservative treatment because of the risk of leaving a microscopic tumor at the site of the preserved ovary.
Albeit no mature evidence is available, accumulating data suggest the safety of fertility-sparing surgery (FSS) in young patients with early stage ovarian cancer (eEOC) [3], [5], [6], [7]. However, consensus concerning the selection criteria for FSS is still lacking. Wide ranges of restrictive criteria are reported across different studies available in medical literature. In fact, although the majority of these studies agree in concept the safety of FSS in patients affected by well-differentiated, ovarian-confined tumors, only few investigations evaluated the effectiveness of this approach in patients affected by poorly differentiated eEOC [6], [7], [8].
In absence of randomized trials on this issue, the evaluation of large retrospective or prospective series is crucial to determinate the long-term effectiveness of FSS. Therefore, we designed the present study to audit our experience in the management of eEOC. The primary goal was to investigate the long-term effectiveness of FSS in young women diagnosed with apparent eEOC. Additionally, as a secondary endpoint, we sought to assess the safety of FSS in low- (well- or moderate-differentiated eEOC) high-risk patients (poorly differentiated or upstaged eEOC).
Section snippets
Materials and methods
After obtaining Institutional Review Board (IRB) approval, we retrospectively searched medical records of all women undergoing FSS for eEOC at National Cancer Institute — Milan (Italy), between February 1975 and January 2011.
Inclusion criteria for FSS were the following: (1) age ≤ 40 years; (2) women interested in preserving their childbearing potential; (3) apparent eEOC (no gross disease in the abdomen) at the time of surgery (4) apparently negative spread to the other ovary (macroscopically or
Results
During the study period, 307 patients undergoing surgical staging for eEOC. Overall, the study group included 70 (22.8%) women who underwent FSS; while 237 (77.2%) patients undergoing RCS represented the control group. Baseline characteristics of the groups are displayed in Table 1. Patients undergoing FSS were younger than patients undergoing RCS. The median age at surgery was 30 (range, 25–35) and 51 (range, 43–58) years for FSS and for RCS, respectively (p < 0.001). Mucinous subtype was the
Discussion
The present study evaluated outcomes of a large series of patients affected by eEOC undergoing FSS and RCS. In our analysis, we observed that stage of disease at presentation is the only factor influencing DFS; while age and high risk disease (FIGO grade 3, stage IA and IB or stage IC or more, regardless on FIGO grade) correlated with a worse OS. FSS is indicated and safe in patients with eEOC FIGO stage IA G1–G2, after accurate comprehensive staging. Patients with high risk disease presented
Conflict of interest statement
No funds have been received. All authors have no financial disclosures.
The authors have no conflict of interest.
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