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Review
. 2021 Sep 18;10(18):4235.
doi: 10.3390/jcm10184235.

Fertility-Sparing Surgery for Ovarian Cancer

Geoffroy Canlorbe  1   2   3 , Nathalie Chabbert-Buffet  2   3   4 , Catherine Uzan  1   2   3
Affiliations
Review

Fertility-Sparing Surgery for Ovarian Cancer

Geoffroy Canlorbe et al. J Clin Med. .

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.

Keywords: borderline ovarian; conservative surgery; epithelial ovarian cancer; fertility sparing surgery; ovarian cancer.

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Conflict of interest statement

The authors declare no conflict of interest in relation to this work.

Figures

Figure 1
Figure 1
Management of infertility (or optimization of infertility) in a young patient with previous history of BOT (ART, assisted reproductive technology; IVF, in vitro fertilization; ICSI, intracytoplasmic sperm injection; IVM, in vitro maturation; BSO, bilateral salpingo-oophorectomy; USO, unilateral salpingo-oophorectomy; AMH: anti-Mullerian hormone; * High-risk recurrent borderline tumor: defined by a recurrent case presenting radiologic (on magnetic resonance imaging) or clinical (recurrence associated with implants) suspicious lesion at the time of the recurrence or histologic high risk factors (peritoneal implants, mucinous tumor with intraepithelial carcinoma, micropapillary patterns, stromal microinvasion) during the treatment of the first tumor (ref Darai et al. Human reprod 2013).
See this image and copyright information in PMC

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