Fertility-sparing surgery for ovarian low malignant potential tumors

Harvard University, Cambridge, Massachusetts, United States
Gynecologic Oncology (Impact Factor: 3.77). 09/2005; 98(2):263-6. DOI: 10.1016/j.ygyno.2005.04.025
Source: PubMed


Ovarian low malignant potential (LMP) tumors have an excellent prognosis when treated by surgical resection. Conservative management usually involves leaving behind the uterus and contralateral adnexa to allow future childbearing. The purpose of this study was to determine the outcome of women treated with fertility-sparing surgery.
All patients diagnosed with ovarian LMP tumors between 1984 and 2003 were identified at three institutions. Data were retrospectively extracted from clinical records.
Thirty-eight (15%) of 249 women with LMP tumors underwent fertility-sparing surgery. Twenty-three were nulliparous and four primiparous. Thirty-three (87%) underwent unilateral salpingo-ophorectomy and five (13%) cystectomy. Fourteen patients also had contralateral cystectomy or biopsy. Thirty-four (89%) were stage I, one (3%) stage II and three (8%) stage III. Most tumors had serous (55%) or mucinous (42%) histology. No patients received adjuvant therapy. Six (16%) of 38 recurred after a median follow-up of 26 months: five in the remaining ovary were salvaged with surgical resection alone, and none died from recurrent LMP tumor. Five women delivered six term infants during post-treatment surveillance.
Fertility-sparing surgery for ovarian LMP tumors is an option for motivated patients. Preservation of the contralateral adnexa increases the risk of recurrence, but surgical resection is usually curative.

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    • "FP in patients with gynecologic cancers can be challenging-gynecologic cancers are heterogeneous, requiring a unique approach for each situation. For now, conservative management is the only FP option in patients with ovarian cancers [31,32,33,34], and borderline ovarian tumors [35,36]. In cervical cancer patients, simple or radical trachelectomy may be an option for FP in patients with early stage disease. "
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    • "Data on the efficacy of this approach are produced essentially by retrospective analysis of patients with suspected malignant ovarian tumours having or not having received a complete laparotomic staging (Morice et al., 2003). The available data regarding the use of laparoscopy for the surgical management of BOTs are also retrospective and obtained by analysis of cases not deliberately approached by laparoscopy but treated conservatively using a laparoscopic access for clinically benign ovarian cysts or tumours (Nezhat et al., 1992; Barnhill et al., 1995; Blanc et al., 1995; Zanetta et al., 1997; Darai et al., 1998; Gotlieb et al., 1998; Seracchioli et al., 2001; Camatte et al., 2002, 2004; Chan et al., 2003; Donnez et al., 2003; Querleu et al., 2003; Maneo et al., 2004; Boran et al., 2005; Deffieux et al., 2005; Desfeux et al., 2005; Fauvet et al., 2005; Rao et al., 2005; Romagnolo et al., 2006). From these findings, it seems that the laparoscopic approach did not change the safety of the fertilitysparing surgery. "
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    ABSTRACT: During the childbearing years, the standard fertility-sparing treatment for bilateral borderline ovarian tumours (BOTs) is the unilateral oophorectomy plus controlateral cystectomy. The aim of the present study was to compare the effects of two laparoscopic fertility-sparing surgical procedures for the treatment of bilateral BOTs on recurrence and fertility in young women who desire to conceive as soon as possible. Thirty-two women affected by bilateral early-stage BOTs who desired to conceive were randomized to receive bilateral cystectomy (experimental group, n=15) or oophorectomy plus controlateral cystectomy (control group, n=17). At the first recurrence after childbearing completion, each patient was treated with non-conservative standard treatment. Recurrences and reproductive events were recorded. After a follow-up period of 81 months (19 inter-quartile; 60-96 range), the cumulative pregnancy rate (CPR) (14/15 versus 9/17; P=0.003) and the cumulative probability of first pregnancy (P= 0.011) were significantly higher in the experimental than in control group. No significant (P=0.358) difference between groups was detected in cumulative probability of first recurrence. The laparoscopic bilateral cystectomy followed by non-conservative treatment performed at the first recurrence after the childbearing completion is an effective surgical strategy for patients with bilateral early-stage BOTs who desire to conceive as soon as possible.
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