Saving Fertility: Success After Surgery for Borderline Ovarian Tumors?
Posted: Tuesday, September 8, 2020
Fertility-sparing surgeries seemed to work well in women of childbearing age with certain borderline ovarian tumors who later wished to conceive, according to a retrospective outcome analysis of 95 women treated in two German hospitals between 2000 and 2018. In Gynecologic Oncology, Andreas du Bois, MD, PhD, of University Hospital, Ludwig-Maximilians-Universität, Munich, and colleagues noted the importance of central pathologic review for accurate staging.
“An external second opinion regarding pathology is mandatory to avoid under- or overtreatment,” they stressed.
The tumors of 77 of the 95 women were diagnosed as FIGO (International Federation of Gynecology and Obstetrics) stage I; 6 women had stage II tumors, 12 had stage III tumors; and 1 was shown to have residual tumor after surgery. Of the 95 women (median age, 30 years), 41 later tried to conceive, and 34 did so. A total of 29 women had at least one live birth. Of the 12 women who did not eventually have a live birth after surgery, 5 previously had children.
Fertility-sparing surgery involves keeping the uterus and at least one ovary intact. When the borderline ovarian tumor is accurately characterized as FIGO stage I, as more than 80% of such tumors are, fertility-sparing surgery is safe and likely to preserve fertility, wrote Dr. du Bois and co-investigators. They noted, too, that in these patients with stage I tumors, even potential recurrence did not statistically affect overall survival.
Of the 95 women, none had any invasive recurrence or disease-related death after a median follow-up of 63 months, and no relapse at all was reported among patients with FIGO stage IA/IC tumors with unilaterally affected ovaries. The high risk of recurrence of tumors that are diagnosed at higher FIGO stages and in both ovaries, however, should be carefully discussed with patients when fertility-sparing surgery is considered, the authors emphasized.
Disclosure: The study authors’ disclosure information can be found at gynecologiconcology-online.net.