To compare reproductive and oncologic outcomes of patients diagnosed with early stage epithelial ovarian carcinoma, borderline ovarian tumors, or non-epithelial ovarian carcinoma according to receipt of fertility-sparing surgery or conventional surgery.
PubMed was searched from January 1, 1995 to May 29, 2020.
Studies were included if they (1) enrolled women of childbearing age diagnosed with ovarian cancer between the ages of 18 and 50 years, (2) reported on oncologic and/or reproductive outcomes after fertility-sparing surgery for ovarian cancer, and (3) included at least 20 patients.
The initial search identified 995 studies. After duplicates were removed, we abstracted 980 unique citations. Of those screened, 167 publications were identified as potentially relevant and evaluated for inclusion and exclusion criteria. The final review included 44 studies in epithelial ovarian cancer, 42 in borderline ovarian tumors, and 31 in non-epithelial ovarian carcinoma. The narrative synthesis demonstrated that overall survival does not appear to be compromised in patients undergoing fertility sparing surgery compared with those undergoing conventional surgery, although long-term data are limited. Areas of controversy include safety of fertility-sparing surgery in the setting of high-risk factors (stage IC, grade 3, and clear cell histology) as well as type of surgery (salpingo-oophorectomy vs. cystectomy). It appears that while there may be some fertility compromise after surgery, pregnancy and live birth rates are encouraging.
Fertility-sparing surgery is safe and feasible in women with early-stage low-risk ovarian cancer. Pregnancy outcomes for these patients also appear to be similar to those of the general population.
Copyright © 2020. Published by Elsevier Inc.