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1167 Fertility sparing in gynaecological cancers – a global review
  1. Zineb Hayati,
  2. Sofia Jayi,
  3. Yassine Belhaj,
  4. Fatima Zohra Fdili Alaoui,
  5. Hekmat Chaara and
  6. Moulay Abdelilah Melhouf
  1. Hassan II University Hospital Center, Fez, Morocco


Introduction/Background Our contemporary societies are observing a postponed motherhood and an ever-increasing incidence of cancers. These factors mean that an increasing number of women of childbearing age will be faced with cancers, that can compromise their fertility, before they accomplish their parental project. In this review, we aim to discuss the existing recommendations on fertility-sparing approaches for women with ovarian, endometrial and cervical cancers and to evaluate the oncologic outcomes of those approaches.

Methodology This literature review conducted on Medline, PubMed and Cochrane databases, included articles from 2018 to 2023.

Results Fertility-sparing surgery (FSS) can be offered to patients with early-stage epithelial ovarian cancer (EOC), borderline ovarian tumor (BOT) or a non-epithelial ovarian tumor. Initial unilateral salpingo-oophorectomy should be considered in case of mucinous BOT, while cystectomy is acceptable in case of serous BOT. The recurrence rate following FSS performed for EOC stage I ranges from 5 to 29%, the mortality ranges from 0 to 18%.

Although there is no consensus on the dosage or duration of treatment, oral progestins can be considered as a fertility sparing option for patients with atypical endometrial hyperplasia or grade 1 endometrial cancer limited to the endometrium. The association of Metformin and hysteroscopic resection seems to improve outcomes, with a complete response rate and a recurrence rate going from 76.3% and 30.7% respectively if progestins alone, to 98.1% and 4.8% respectively if endometrial resection associated.

Within a population of low risk of cervical cancer recurrence, a FSS such as conization or trachelectomy with evaluation of the pelvic node status, can be performed. However, for patients with a higher risk of recurrence abdominal radical trachelectomy or neoadjuvant chemotherapy, followed by FSS can be considered.

Conclusion Fertility sparing approaches along with assisted reproductive technologies may give a hope treating gynaecological cancers while preserving fertility.

Disclosures All authors declare no conflicts of interest. This study did not receive any funding.

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