Outcomes of fertility-sparing surgery for invasive epithelial ovarian cancer: oncologic safety and reproductive outcomes

Abstract

Objective: Younger patients with invasive epithelial ovarian cancer (EOC) frequently want to preserve their fertility, but the role of fertility-sparing surgery in EOC has not been well defined. We therefore assessed tumor recurrence, patient survival and pregnancy outcomes in patients with invasive EOC who underwent fertility-sparing surgery.

Methods: Records of 62 patients with invasive EOC who underwent fertility-sparing surgery, defined as the preservation of ovarian tissue in one or both adnexa and the uterus, between May 1990 and October 2006, were retrospectively reviewed.

Results: Of the 62 EOCs, 36 were stage IA, 2 were stage IB, 21 were stage IC, and 1 each was stage IIB, IIIA, and IIIC; 48 were grade I, 5 were grade II, and 9 were grade III. Forty-eight patients received platinum-based adjuvant chemotherapy (mean 4.6 cycles, range 1-9 cycles). At a median follow-up of 56 months (range, 6-205 months), 11 patients had tumor recurrence, 6 died of disease, 2 were alive with disease, and 54 were alive without disease. Patients with stage >IC (p=0.0014) or grade III (p=0.0002) tumors had significantly poorer survival. Nineteen women attempted to conceive, and there were 22 term pregnancies, with no congenital anomalies in any of the offspring.

Conclusion: Fertility-sparing surgery can be considered in young patients with stages IA-C and grades I-II EOCs who desire to preserve their fertility.