Author(s): Ana Victoria V. Dy Echo, M.D., F.P.O.G.S. and Jericho Thaddeus P. Luna, M.D., F.P.O.G.S.
As ovarian cancer is increasingly diagnosed among reproductive aged women, fertility sparing surgery (FSS) becomes an important management option.
A five-year (2005-2009) retrospective study was conducted at a tertiary hospital to determine the fertility and clinical outcomes of ovarian cancer patients who underwent FSS.
Patients 16-40 years old who underwent FSS were evaluated. Review of medical records was done to determine clinic-surgico-pathologic demographics. Menstrual, fertility and clinical outcomes were the main outcomes measured.
Forty-four cases (mean age 24 years) were evaluated: 27 epithelial tumors, 16 germ cell tumors and 1 sex cord stromal tumor. Forty-one cases (93.18%) were stage I, while 3 cases (6.82%) had advanced stages. Complete surgical staging was done in 19 (43.18%) patients. At the end of treatment, all patients had restoration of menses 1-2 months after initial surgery with no significant interruption in menses among the 7 patients given platinum-based chemotherapy. There were 15 pregnancies (83.33%), with 2 patients having 2 pregnancies each. There were only 5 patients (27.78%) with infertility, 3 of which already had infertility prior to the surgery. There were 8 (18.18%) cases of tumor persistence/recurrence, all of which were malignant germ cell tumors without adjuvant chemotherapy.
This study suggests that FSS is a safe and acceptable treatment for reproductive-age women, particular those less than 30 years old with no history of infertility, with either stage I epithelial tumors (low malignant potential and frank carcinoma) or malignant germ cell tumors with assured adjuvant chemotherapy.
Key words: fertility-sparing surgery, ovarian cancer