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Original research
Fertility-sparing surgery for patients with stage IC2 or IC3 epithelial ovarian carcinoma: any evidence of safety?
  1. Dimitrios Nasioudis,
  2. Quetrell D Heyward,
  3. Emily M Ko,
  4. Ashley F Haggerty,
  5. Lori Cory,
  6. Robert L Giuntoli II,
  7. Sarah H Kim and
  8. Nawar A Latif
  1. Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Dimitrios Nasioudis, Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA; dimitrios.nasioudis{at}uphs.upenn.edu

Abstract

Objective Investigate the overall survival of patients with stage IC2/IC3 epithelial ovarian carcinoma undergoing fertility-sparing surgery.

Methods Patients aged <45 years diagnosed between January 2004 and December 2015 with epithelial ovarian carcinoma, who underwent surgical staging and had tumor involving the ovarian surface (IC2), malignant ascites or positive cytology (IC3), were identified in the National Cancer Database. The fertility-sparing surgery group included patients who had preservation of the uterus and the contralateral ovary while the radical surgery group included patients who had hysterectomy with bilateral salpingo-oophorectomy. Overall survival was evaluated following generation of Kaplan–Meier curves while a Cox model was constructed to control for tumor grade and performance of lymphadenectomy. A systematic review of the literature was performed and cumulative relapse rate among patients with IC2/IC3 disease who underwent fertility-sparing surgery was calculated.

Results A total of 235 cases were identified; 105 (44.7%) patients underwent fertility-sparing surgery. There was no difference in overall survival between the fertility-sparing and radical surgery groups (p=0.37; 5- year overall survival rates 90.2% and 85%, respectively). After controlling for tumor grade and performance of lymphadenectomy, fertility-sparing surgery was not associated with worse overall survival (HR 1.22, 95% CI 0.56, 2.62). A systematic review identified 151 patients with stage IC2/IC3 disease who underwent fertility-sparing surgery. Cumulative relapse rate was 19.3% (n=29) while 12 (6.7%) deaths were reported. Median time to recurrence was 19 (range 1–128.5) months. Tumor recurrence involved the ovary exclusively in 42% (11/26) of patients, while 15% (4/26) had a lymph node, 35% (9/26) a pelvic/abdominal, and 8% (2/26) a distant tumor relapse.

Conclusions In a large cohort of patients with stage IC2/IC3 epithelial ovarian carcinoma, fertility-sparing surgery was not associated with worse overall survival. However, based on a literature review, relapse rate is approximately 20%.

  • ovarian cancer
  • surgery
  • hysterectomy

Data availability statement

Data may be obtained from a third party and are not publicly available. Data obtained from the American College of Surgeons.

https://doi.org/10.1136/ijgc-2021-003115

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data obtained from the American College of Surgeons.

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    Footnotes

    • Contributors DN: conception, data collection, statistical analysis, critical analysis, drafting/final editing, guarantor. QDH: data collection, critical analysis, drafting/final editing. AFH, EMK, SK, LC, RLG: critical analysis, drafting/final editing. NL: supervision, critical analysis, drafting/final editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.