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Fertility-sparing surgery in epithelial ovarian cancer

For clinicians Gynecologic Journal articles Surgery

Since the last two decades, the feasibility of fertility-sparing surgery in early-stage epithelial ovarian cancer has been explored by several teams. Despite the impossibility of conducting a randomized trial to validate this management, evidence-based data suggest that in selected cases, the preservation of the uterus and at least one part of the ovary does not lead to a high risk of relapse. Conservative surgery maintains organ function, enables patients of childbearing age to preserve their fertility and improves their quality of life. In this review, we analyze the main series in the literature on this topic in order to highlight the selected criteria for conservative management and to summarize oncological and fertility outcomes.

Conservative and functional surgery is increasingly used in surgical oncology. Its aim is to maintain organ function and to reduce the radicality of surgery so that patients of childbearing age may preserve their fertility. The development of new minimally invasive procedures in oncologic gynecologic surgery is a perfect example of how the landscape of surgical management has evolved. Although radical surgery remains the gold standard in the treatment of epithelial ovarian cancer (EOC), fertility-sparing surgery (FSS) can be considered in patients with early-stage disease (stage I FIGO [The International Federation of Gynecology and Obstetrics] [1]), in order to preserve their fertility and improve their quality of life. These procedures can only be proposed to selected patients, depending on the tumor grade, disease stage, histologic subtypes and prognostic factors. Although this topic has fueled debate during the last two decades, a consensus regarding selection criteria has yet to be reported in the literature.

The aim of this review is to clarify the selection criteria for FSS in EOC, the outcome and the fertility rate of these patients by summarizing the main data in the literature between 1994 and 2015.

Click here to view the full article in Future Oncology.