An excellent prognosis was associated with either radical surgery or fertility-sparing surgery for women with stage I nonepithelial ovarian cancer, according to the results of a prospective study comparing these 2 surgical approaches that was published in Gynecologic Oncology.

Unlike radical surgery in ovarian cancer, which includes bilateral salpingo-oophorectomy and total abdominal hysterectomy, fertility-sparing surgery involves preservation of at least a part of one ovary and the uterus. The latter approach is particularly relevant for younger women with early-stage disease who wish to preserve their fertility.

This population-based study included prospectively collected data for all women aged 18 to 40 years with stage I nonepithelial ovarian cancers (ie, germ-cell tumors and sex-cord stromal tumors; N=73) included in the Swedish Quality Register for Gynecological Cancer between 2008 and 2015.

Of these patients, approximately three-quarters (n=57) underwent fertility-sparing surgery. Women who underwent radical surgery were more likely to be older, mean age of 34 years vs 29 years for those treated with fertility-sparing surgery (P =.0016), and to have a higher parity (P =.001).

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Some of the key study findings were as follows:

  • The 5-year overall survival rate was 98% for the total patient cohort; 100% and 92% for those undergoing fertility-sparing surgery and radical surgery, respectively;
  • At a mean follow-up of 65 months for those treated with fertility-sparing surgery and 72 months in the group treated with radical surgery, disease recurrence rates were 3.5% (n=2) and 12.5% (n=2), respectively;
  • Eleven women (19%) gave birth to a total of 13 healthy, naturally conceived, full-term children following fertility-sparing surgery;
  • Twelve percent of women in the fertility-sparing surgery cohort (n=7) underwent assisted reproductive therapy for infertility, with no recorded births.

In their concluding remarks, the study authors noted that “fertility-sparing surgery may be indicated for women of fertile age with early-stage nonepithelial ovarian cancer and a future fertility wish.”

Reference

Johansen G, Dahm-Kähler P, Staf C, et al. Fertility-sparing surgery for treatment of non-epithelial ovarian cancer: Oncological and reproductive outcomes in a prospective nationwide population-based cohort study.Gynecol Oncol. 2019;155(2):287-293.