Fertility-sparing surgical management of ovarian cancer

Abstract

Introduction: Ovarian cancer (OC) continues to be one of the greatest challenges of modern oncology gynecology. Most patients are diagnosed in the advanced stage of the disease, which requires aggressive and extensive surgical intervention. In approximately 8% of the cases, OC affects women <40 years of age. Among them, early-stage OC FIGO IA accounts for 40% of the affected individuals, which allows for fertility-sparing surgical management. Objectives: The aim of the study was to evaluate the efficacy of fertility-sparing management in OC women, with tumor limited to one ovary, who wish to preserve their fertility. Material and methods: A total of 43 women with OC limited to one ovary (26 with borderline malignant tumors and 17 with invasive tumor FIGO IA) underwent surgical sparing therapy. Disease recurrence rate as the measure of the quality of treatment and the number of pregnancies, together with their course, as the measure of the effectiveness of the fertility-sparing therapy were evaluated. Results: The observation period, from 4-10 years for borderline malignancy and 3-8 years for invasive FIGO IA tumor, revealed no cases of disease recurrence. In the former group, 14 (73.%) women conceived, out of whom 2 miscarried before 22 weeks of gestation, 1 give birth pre-term, i.e. at 34 weeks of gestation, 10 (71.5%) gave birth at term, and 1 is pregnant (6 months) at the time of the publication of the study. In the later group, 9 (81.8%) women conceived, out of whom 1 miscarried at 10 weeks of gestation, 1 had a case of intrauterine fetal demise at 27 weeks of gestation, 6 gave birth at term, and 1 is pregnant (3 months) at the time of the publication of the study. Conclusions: Proper patients selection for fertility-sparing management, as well as the way of performing the surgery allow for adequate control of the malignant process in patients with tumor limited to one ovary, and preservation of fertility.