1
|
Gao H, Wei W, Li Y, Wei H, Wang N. Does controlled ovarian hyperstimulation in women with a history of borderline tumor influence recurrence rate? Arch Gynecol Obstet 2024; 309:1515-1523. [PMID: 37750934 PMCID: PMC10894088 DOI: 10.1007/s00404-023-07103-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 06/06/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE To determine the recurrence rate in the women with controlled ovarian hyperstimulation after a history of borderline ovarian tumors (BOT). METHODS This was a retrospective analysis of 275 patients with BOT undergoing surgery for fertility preservation in our hospital between 2001 and 2017. Cases were divided into an assisted reproductive technology (ART) treatment group (n = 15) and a non-ART treatment group (n = 260). We compared the recurrence rate, survival rate and pregnancy outcomes between these two groups. RESULTS The ART group had a higher recurrence rate (33.33% vs. 10.80%, P = 0.023). Survival analysis indicated that the recurrence time in patients undergoing ART was significantly shorter (P = 0.026). A low pregnancy rate before diagnosis, and high intraoperative blood loss, were associated with postoperative ART treatment (P < 0.05). Multivariate analysis showed that ART treatment and bilateral lesions both significantly increased the risk of recurrence (P < 0.05). The pathological type of recurrent tumors was often the same as the initial tumor. CONCLUSION The postoperative use of ART in patients with BOT significantly increased the recurrence rate, but does not significantly affect the overall survival rate of patients. Therefore, ART in such patients should be individualized, and close follow-up is necessary after ART.
Collapse
Affiliation(s)
- Han Gao
- Department of Obstetrics and Gynecology, Affiliated Hospital of Inner Mongolia Minzu University, Tongliao, China
| | - Wei Wei
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian City, 116027, Liaoning Province, China
| | - Yibing Li
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian City, 116027, Liaoning Province, China
| | - Heng Wei
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ning Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian City, 116027, Liaoning Province, China.
| |
Collapse
|
2
|
Raimondo D, Raffone A, Scambia G, Maletta M, Lenzi J, Restaino S, Mascilini F, Trozzi R, Mauro J, Travaglino A, Driul L, Casadio P, Mollo A, Fagotti A, Vizzielli G, Seracchioli R. The impact of hysterectomy on oncological outcomes in postmenopausal patients with borderline ovarian tumors: A multicenter retrospective study. Front Oncol 2022; 12:1009341. [PMID: 36387131 PMCID: PMC9647053 DOI: 10.3389/fonc.2022.1009341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/12/2022] [Indexed: 11/21/2022] Open
Abstract
Data about the oncological outcomes in women with borderline ovarian tumor (BOT) undergoing uterine-sparing surgery without ovarian preservation are poor. We aimed to assess the oncological outcomes in women with BOT undergoing uterine-sparing surgery without ovarian preservation. A multi-center observational retrospective cohort study was performed including all consecutive postmenopausal patients who underwent surgical treatment for BOT at three tertiary level referral centers for gynecologic oncology from January 2005 to December 2016. Patients were divided into two groups for comparisons: patients undergoing hysterectomy (hysterectomy group) and patients undergoing uterine-sparing surgery (no hysterectomy group). Study outcomes were disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS) and surgical complications rate. Ninety-eight patients were included: 44 in the hysterectomy group and 54 in the no hysterectomy group. The 5- and 10-year DFS rates were 97.7% (95% CI: 84.9–99.7) and 92.3% (95% CI: 69.7–98.2), in the hysterectomy group, and 86.8% (95% CI: 74.3–93.5) and 86.8% (95% CI: 74.3–93.5), in the no hysterectomy group, respectively, without significant differences (p=0.16). Hazard ratio for DFS was 0.26 (95% CI: 0.06–1.68) for the hysterectomy group. The 5- and 10-year OS rates were 100.0% (95% CI: -) and 100.0% (95% CI: -), in the hysterectomy group, and 98.2% (95% CI: 87.6–99.7) and 94.4% (95% CI: 77.7–98.7), in the no hysterectomy group, respectively, without significant differences (p=0.23). No significant difference in complication rate was reported among the groups (p=0.48). As hysterectomy appears to not impact survival outcomes of women with BOT, it might be avoided in the surgical staging.
Collapse
Affiliation(s)
- Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, Istituto di ricovero e cura a carattere scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Raffone
- Division of Gynaecology and Human Reproduction Physiopathology, Istituto di ricovero e cura a carattere scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
- *Correspondence: Antonio Raffone, ; ; Giovanni Scambia,
| | - Giovanni Scambia
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- *Correspondence: Antonio Raffone, ; ; Giovanni Scambia,
| | - Manuela Maletta
- Division of Gynaecology and Human Reproduction Physiopathology, Istituto di ricovero e cura a carattere scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Restaino
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital – Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Floriana Mascilini
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rita Trozzi
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jessica Mauro
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital – Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- University of Udine – Department of Medical Area (DAME), Udine, Italy
| | - Antonio Travaglino
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital – Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- University of Udine – Department of Medical Area (DAME), Udine, Italy
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, Istituto di ricovero e cura a carattere scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Anna Fagotti
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital – Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- University of Udine – Department of Medical Area (DAME), Udine, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, Istituto di ricovero e cura a carattere scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| |
Collapse
|
3
|
Della Corte L, Mercorio A, Serafino P, Viciglione F, Palumbo M, De Angelis MC, Borgo M, Buonfantino C, Tesorone M, Bifulco G, Giampaolino P. The challenging management of borderline ovarian tumors (BOTs) in women of childbearing age. Front Surg 2022; 9:973034. [PMID: 36081590 PMCID: PMC9445208 DOI: 10.3389/fsurg.2022.973034] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/09/2022] [Indexed: 11/14/2022] Open
Abstract
Borderline ovarian tumors (BOTs) account for approximately 15% of all epithelial ovarian cancers. In 80% of cases the diagnosis of BOTs is done at stage I and more than a third of BOTs occurs in women younger than 40 years of age wishing to preserve their childbearing potential; the issue of conservative surgical management (fertility-sparing treatment) is thus becoming of paramount importance. At early stages, the modalities of conservative treatment could range from mono-lateral cystectomy to bilateral salpingo-oophorectomy. Although cystectomy is the preferred method to promote fertility it can lead to an elevated risk of recurrence; therefore, an appropriate counseling about the risk of relapse is mandatory before opting for this treatment. Nevertheless, relapses are often benign and can be treated by repeated conservative surgery. Besides the stage of the disease, histological subtype is another essential factor when considering the proper procedure: as most mucinous BOTs (mBOTs) are more commonly unilateral, the risk of an invasive recurrence seems to be higher, compared to serous histotype, therefore unilateral salpingo-oophorectomy is recommended. In the appraisal of current literature, this review aims to gain better insight on the current recommendations to identify the right balance between an accurate staging and an optimal fertility outcome.
Collapse
Affiliation(s)
- Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Mercorio
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
- Correspondence: Antonio Mercorio
| | - Paolo Serafino
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesco Viciglione
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Mario Palumbo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | | | - Maria Borgo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Cira Buonfantino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Marina Tesorone
- Department of Child and Adolescent Health, U.O.C Protection of Women's- ASL Napoli 1, Naples, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | | |
Collapse
|
4
|
Raimondo D, Raffone A, Zakhari A, Maletta M, Vizzielli G, Restaino S, Travaglino A, Krishnamurthy S, Mabrouk M, Casadio P, Mollo A, Scambia G, Seracchioli R. The impact of hysterectomy on oncological outcomes in patients with borderline ovarian tumors: A systematic review and meta-analysis. Gynecol Oncol 2022; 165:184-191. [DOI: 10.1016/j.ygyno.2022.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
|
5
|
Fertility preservation strategies in borderline ovarian tumor recurrences: different sides of the same coin. J Assist Reprod Genet 2020; 37:1217-1219. [PMID: 32189179 DOI: 10.1007/s10815-020-01738-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 12/31/2022] Open
|
6
|
Fayez I, Khreisat B, Athamneh T, Omoosh R, Daibes MA. Multiple Bilateral Ovarian Mature Cystic Teratomas with Ovarian Torsion: A Case Report. Oman Med J 2018; 33:163-166. [PMID: 29657687 DOI: 10.5001/omj.2018.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Ovarian tumors are a common form of neoplasm in women. Mature cystic teratoma is the most common type, with a bilateral incidence of 8-15%. However, few cases are reported as bilateral and multiple. A rare case of bilateral multiple dermoid cysts in a 19-year-old female patient presented with abdominal pain of one-day duration. Her medical history was unremarkable. Ultrasonography showed multiple bilateral ovarian cystic masses. The patient underwent laparotomy. The masses were excised while preserving the remaining ovarian tissue. Histopathology confirmed the diagnosis of multiple mature cystic teratomas with no presence of malignant tissue.
Collapse
Affiliation(s)
- Iman Fayez
- Department of Obstetrics and Gynecology, King Hussein Medical Center, Amman, Jordan
| | - Basel Khreisat
- Department of Obstetrics and Gynecology, King Hussein Medical Center, Amman, Jordan
| | - Tarek Athamneh
- Department of Obstetrics and Gynecology, Prince Rashid Ibn Al-Hasan Hospital, Irbid, Jordan
| | - Reema Omoosh
- Department of Obstetrics and Gynecology, King Hussein Medical Center, Amman, Jordan
| | | |
Collapse
|
7
|
Prognostic Factors for Recurrence After Fertility-Preserving Surgery in Patients With Borderline Ovarian Tumors: A Systematic Review and Meta-analysis of Observational Studies. Int J Gynecol Cancer 2018; 27:1833-1841. [PMID: 28816706 DOI: 10.1097/igc.0000000000001092] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to find the unfavorable prognostic factors for recurrence after fertility-preserving surgery (FPS) in patients with borderline ovarian tumors (BOTs). METHODS To perform a meta-analysis to compare the recurrence rates of BOT patients after FPS according to different prognostic factors, we searched PubMed, EMBASE, and Cochrane for observational studies. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with a fixed-effects model. RESULTS We analyzed 32 studies that included 2691 BOT patients who underwent FPS, 383 patients of whom had a relapse in the follow-up. In meta-analysis, risks associated with recurrence in patients with unilateral cystectomy (OR, 2.49; 95% CI, 1.86-3.33) or serous borderline ovarian tumors (OR, 3.15; 95% CI, 1.97-5.02) were significantly increased, and there was no significantly increased OR for patients with laparoscopy compared with those with laparotomy (OR, 0.96; 95% CI, 0.57-1.60). CONCLUSIONS Unilateral cystectomy (19.4%) and serous BOTs (19.2%) are significantly associated with higher recurrence rates, and no negative impact of laparoscopy on recurrence can be demonstrated when compared with laparotomy in the meta-analysis.
Collapse
|
8
|
Ratanasrithong P, Benjapibal M. Pregnancy Outcomes after Conservative Surgery for Early-Stage Ovarian Neoplasms. Asian Pac J Cancer Prev 2017; 18:2083-2087. [PMID: 28843226 PMCID: PMC5697464 DOI: 10.22034/apjcp.2017.18.8.2083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective: This retrospective, single institute study aimed to evaluate pregnancy and oncologic outcomes in reproductive-age Thai women with early-stage ovarian neoplasms undergoing conservative surgical treatment. Methods: Medical records of 84 women of reproductive age (15-45 years) with histologically confirmed early-stage (IA-IIC) borderline ovarian tumors or cancers who had undergone conservative surgery between January 2003 and December 2012 were retrospectively reviewed. Results: The mean age of patients at diagnosis was 28.0 years (SD 7.2). Histologically, 30 (35.7%) had borderline ovarian tumors, 28 (33.3%) epithelial cancers, 22 (26.2%) malignant germ cell tumors, and 4 (4.8%) sex cord stromal tumors. Thirty-five women (41.7%) had complete surgical staging performed, whereas 49 (58.3%) underwent an incomplete staging procedure. Thirty-four patients (40.5%) received postoperative chemotherapy. Among 29 patients subsequently attempting pregnancy, 15 conceived successfully (51.7%). Pregnancy outcomes were one spontaneous abortion and 14 viable births. There were no serious adverse obstetric and neonatal outcomes among women with documented live births and no reported fetal abnormalities. Pregnancy rates were not impacted by surgical staging (53.8% vs 50.0%, p=0.837) or adjuvant chemotherapy (55.6% vs 50.0%, p=0.782). The 5-year disease-free survival was 91.0% and pregnancy after conservative surgery did not affect progression-free survival (p=0.194). Conclusion: Conservative surgery with or without appropriate adjuvant chemotherapy can be offered to young women with early-stage ovarian neoplasms who wish to preserve their fertility potential.
Collapse
Affiliation(s)
- Panwad Ratanasrithong
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | | |
Collapse
|
9
|
Fertility preservation in women with borderline ovarian tumours. Cancer Treat Rev 2016; 49:13-24. [DOI: 10.1016/j.ctrv.2016.06.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 12/15/2022]
|
10
|
Abstract
Objective: To show the feasibility and safety of robotic-assisted laparoscopic fertility-sparing surgery for early-stage ovarian cancer in women of reproductive age. Methods and Design: The first patient was a 29-year-old para 0 woman with well-differentiated endometrioid adenocarcinoma of the ovary and complex endometrial hyperplasia with marked atypia. The second patient was a 31-year-old para 0 woman with an immature grade 1 teratoma. Both patients underwent robotic-assisted laparoscopic surgical staging. Results: In the first patient, there were no intra- or postoperative complications. Operative time was 5 hours 43 minutes and estimated blood loss was 100 mL. She was discharged home on postoperative day 1. She received 3 cycles of carboplatin and paclitaxel, as well as medroxyprogesterone acetate for the duration of chemotherapy. She conceived twice spontaneously since surgery and had two successful deliveries. She currently has no evidence of disease. In the second patient, there were no intra- or postoperative complications. Operative time was 2 hours 52 minutes and estimated blood loss was 200 mL. She was discharged home on postoperative day 1. She declined adjuvant chemotherapy with bleomycin, etoposide, and cisplatin. She conceived spontaneously 4 months later and had a normal vaginal delivery. She currently has no evidence of disease. Conclusions: Because fertility-sparing surgery is now accepted as a viable option in young women with early-stage ovarian cancer, less invasive techniques are being used. With the advent of robotic-assisted surgery and its advantages over conventional laparoscopy, we show that it is a safe and feasible approach in select patients. This is the first reported series on robotic fertility-sparing surgery, but more research is needed.
Collapse
Affiliation(s)
| | - Farr Reza Nezhat
- St Luke's-Roosevelt Hospital Center, 425 W 59th St, Suite 9B, New York, NY, 10019, USA..
| |
Collapse
|
11
|
Cosentino F, Turco LC, Cianci S, Fanfani F, Fagotti A, Alletti SG, Vizzielli G, Vitale SG, Laganà AS, Padula F, Coco C, Pisconti S, Scambia G. Management, prognosis and reproductive outcomes of borderline ovarian tumor relapse during pregnancy: from diagnosis to potential treatment options. J Prenat Med 2016; 10:8-14. [PMID: 28725340 DOI: 10.11138/jpm/2016.10.1.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND fertility sparing surgery is the first option for treatment of childbearing age women affected by borderline ovarian tumor (BOT). This review put in evidence the benefits and the risks of conservative surgery procedure. Moreover, the literature review is aimed to analyze the possibility of fertility sparing surgery in BOTs and to define a standard treatment in the management of this pathology during pregnancy. METHODS systematic analysis of the relevant literature for fertility sparing during pregnancy for BOT, accessed through MEDLINE (1982-2015), bibliographies, and interactions with investigators. The data were assimilated into a rigorous and objective contemporary description, enriched by prospective, controlled, and evidence-based studies. RESULTS there are not many studies about BOT during pregnancy. It can reasonably assumed that after the diagnosis of a suspected BOT during the third trimester of pregnancy, an attitude of close surveillance could be adopted. To the best of our knowledge, we report the only case in literature focused about the treatment and management of borderline ovarian tumor relapse detected during pregnancy. CONCLUSION basing on our experience and on literature reported, the conservative management of BOT during gestation up to delivery could be considered feasible. The conservative debulking surgery should be performed at the time of cesarean section in a third referral center for gynecologic oncology.
Collapse
Affiliation(s)
- Francesco Cosentino
- Division of Gynecologic Oncology, Department of Oncology, Fondazione di Ricerca e Cura Giovanni Paolo II, Catholic University of the Sacred Hearth, Campobasso, Italy
| | - Luigi Carlo Turco
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy
| | - Stefano Cianci
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Italy
| | - Francesco Fanfani
- Department of Obstetrics and Gynecology, University of Chieti Gabriele D'Annunzio, Chieti, Italy
| | - Anna Fagotti
- Division of Minimally Invasive Gynecological Surgery, St. Mary Hospital Terni, University of Perugia, Terni, Italy
| | - Salvatore Gueli Alletti
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy
| | - Giuseppe Vizzielli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy
| | - Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Italy
| | - Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Italy
| | - Francesco Padula
- Department of Gynecologic Ultrasound Imaging, Altamedica Fetal Maternal Medical Centre, Rome, Italy
| | - Claudio Coco
- Department of Gynecologic Ultrasound Imaging, Altamedica Fetal Maternal Medical Centre, Rome, Italy
| | - Salvatore Pisconti
- Medical Oncology Unit, Azienda Ospedaliera SS. Annunziata, Taranto, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy
| |
Collapse
|
12
|
Vasconcelos I, de Sousa Mendes M. Conservative surgery in ovarian borderline tumours: a meta-analysis with emphasis on recurrence risk. Eur J Cancer 2015; 51:620-31. [PMID: 25661104 DOI: 10.1016/j.ejca.2015.01.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/24/2014] [Accepted: 01/01/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent reports have stirred the debate regarding the optimal conservative treatment for both serous and mucinous borderline ovarian tumour (BOT). The aim of this study is to examine the optimal oncological approach of conservative surgery in unilateral BOT (cystectomy (C) versus unilateral salpingo-oophorectomy (USO)) and in bilateral BOT (bilateral C (BC) versus USO+contralateral C (CC)), as well as fertility outcomes. MATERIALS AND METHODS The PubMed database and Cochrane Library were searched using the search terms (((Borderline) OR (low malignant potential)) AND (ovarian)) AND ((tumour) OR (cancer)) AND (((fertility sparing) OR (conservative)) AND surgery). RESULTS We analysed 39 studies that included 5105 women (2624 patients with serous-, 2120 patients with mucinous- and the remaining with other types of BOT), 2752 of which underwent conservative surgery (817 underwent C, 89 BC, 1686 USO and 118 USO+CC). Eight studies included only stage I patients, in 14 studies more than 90% of patients were stage I and five studies included only late-stage patients. Seven studies included only patients with serous borderline ovarian tumour (sBOT) and two only mucinous borderline ovarian tumour (mBOT). A total of 296 patients with non-invasive-, 76 patients with invasive- and 50 patients with unspecified implants were pooled. Of the patients undergoing C, BC, USO and USO+CC the pooled recurrence estimates were respectively 25.3%, 25.6%, 12.5% and 26.1%. In meta-analysis, USO was significantly favored over C with an OR for recurrence reduction=2200, 95% CI=0.793-2.841 and p<0.0001. The pooled recurrence estimate as invasive ovarian cancer was 15.4% and the pooled 95% CI was 0.120-0.196. The cumulative pregnancy rate was 55.7% with 45.4% for USO and 40.3.0% for C. CONCLUSION Cystectomy in unilateral serous BOT is significantly associated with a higher recurrence rate, albeit no impact on survival can be demonstrated. Whether this is related to the duration of follow-up, remains to be proven. Nonetheless, recent data seem to suggest that USO is advisable in the case of mucinous BOT. On the contrary, a more conservative approach (BC) should be definitively favored in bilateral BOT, which is almost always serous, because no significant difference is seen in terms of recurrence rate when compared to USO+CC.
Collapse
Affiliation(s)
- Inês Vasconcelos
- Charité, Gynecology Department, Charitéplatz 1, 10117 Berlin, Germany
| | - Miguel de Sousa Mendes
- Vivantes Neukolln Clinic, Obstetrics Department, Rudower Straße 48, 12351 Berlin, Germany
| |
Collapse
|
13
|
Alvarez RM, Vazquez-Vicente D. Fertility sparing treatment in borderline ovarian tumours. Ecancermedicalscience 2015; 9:507. [PMID: 25729420 PMCID: PMC4335965 DOI: 10.3332/ecancer.2015.507] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Indexed: 01/24/2023] Open
Abstract
Borderline ovarian tumours are low malignant potential tumours. They represent 10-15% of all epithelial ovarian malignancies. Patients with this type of tumour are younger at the time of diagnosis than patients with invasive ovarian cancer. Most of them are diagnosed in the early stages and have an excellent prognosis. It has been quite clearly established that the majority of borderline ovarian tumours should be managed with surgery alone. Because a high proportion of women with this malignancy are young and the prognosis is excellent, the preservation of fertility is an important issue in the management of these tumours. In this systemic review of the literature, we have evaluated in-depth oncological safety and reproductive outcomes in women with borderline ovarian tumours treated with fertility-sparing surgery, reviewing the indications, benefits, and disadvantages of each type of conservative surgery, as well as new alternative options to surgery to preserve fertility.
Collapse
Affiliation(s)
- Rosa Maria Alvarez
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London EC1A 7BE, UK
| | | |
Collapse
|
14
|
Hamed AH, Emerson R, Bonaventura L, Saso S, Del Priore G. Pregnancy after laparoscopic bilateral partial ovarian decortication for stage IC borderline ovarian tumour. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:826-829. [PMID: 25222363 DOI: 10.1016/s1701-2163(15)30486-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Fertility preservation techniques are a growing area of research as more women in the reproductive age group develop gynaecologic cancers. We report here a novel technique of fertility preservation used in the treatment of a patient with borderline ovarian tumour. CASE A 29-year-old woman with stage I borderline ovarian tumour was referred to our tertiary level hospital. She had a history of infertility and requested fertility preservation be considered in treatment decisions. We performed bilateral laparoscopic partial decortication of the ovaries, and the patient successfully conceived spontaneously following the procedure. CONCLUSION Fertility-preserving surgery should be an option for young women with borderline ovarian tumours who wish to retain fertility. Removing abnormal ovarian tissue may restore fertility. The laparoscopic approach is safe and feasible for these patients.
Collapse
Affiliation(s)
- Ali Hassan Hamed
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Indiana University School of Medicine, Indianapolis IN; Department of Obstetrics and Gynecology, Assiut University, Egypt
| | - Robert Emerson
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis IN
| | - Leo Bonaventura
- Reproductive Medicine, American Health Network, Indianapolis IN
| | - Srdjan Saso
- Institute of Reproductive and Developmental Biology, Imperial College, London, UK
| | - Giuseppe Del Priore
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Indiana University School of Medicine, Indianapolis IN
| |
Collapse
|
15
|
Chang CF, Lin CK. A case of recurrent, bilateral ovarian mature teratoma in a young woman. BMC WOMENS HEALTH 2014; 14:57. [PMID: 24726009 PMCID: PMC3996130 DOI: 10.1186/1472-6874-14-57] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 04/09/2014] [Indexed: 11/23/2022]
Abstract
Background Ovarian mature cystic teratomas are common, benign, pelvic tumors that are easily detected by pelvic ultrasonography. However, patients with recurrent teratomas are rarely noted, and cases of bilateral teratomas are even less common. Case presentation A young woman with a recurrent, right ovarian teratoma had previously undergone surgical removal 2 times. After the second surgery, she underwent regular out-patient follow-up, and no residual tumor was observed. However, 3 years after the second surgery, she developed recurrent, bilateral ovarian teratomas, in conjunction with elevated carbohydrate antigen-125 levels. Conclusion Routine checking of the contralateral ovary during the surgical procedure along with frequent postoperative pelvic sonography for both ovaries in the patient at high recurrence rich is necessary. Additionally, the features of that kind tumor may mislead the surgeon into performing more extensive surgery that might compromise the fertility of young patients.
Collapse
Affiliation(s)
| | - Chen-Kuo Lin
- Department of Obstetrics and Gynecology, Taoyuan Armed Forces General Hospital, No,168, Zhongxing Rd,, Longtan Township, Taoyuan County, 32551, Taiwan.
| |
Collapse
|
16
|
Association Between Reproductive Cancer and Fetal Outcomes: A Systematic Review. Int J Gynecol Cancer 2013; 23:1171-7. [DOI: 10.1097/igc.0b013e31829e9fe2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThis study aimed to review studies that addressed the impact of previous reproductive cancer diagnosis on selected fetal birth outcomes.Materials and MethodsWe searched PubMed and Web of Knowledge to identify peer-reviewed articles published from January 1992 to December 2012, investigating the association between reproductive cancer and birth outcomes. After applying exclusion criteria, 49 articles were identified for full review, and 36 articles were finally selected for this systematic review. The quality of the studies was assessed by independent reviewers.ResultsWe found 13 cervical cancer studies, 16 ovarian cancer studies, and 7 corpus uteri cancers that reported subsequent pregnancies (n = 688 pregnancies in 477 women). Of these, 489 pregnancies reached third trimester. Among viable pregnancies, only 416 pregnancies had information on maturity status based on gestational age and/or birth weight. For those with cervical cancer, the preterm birth (PTB) rate was 48.5%. For those with ovarian cancer, there were no cases of PTB. For those with corpus uteri cancers, the PTB was 7.7%. All studies had small sample sizes, and there was considerable heterogeneity of results. Abortions, ectopic pregnancies, and terminations were also reported.ConclusionsReproductive cancers may be associated to subsequent adverse fetal birth outcomes; however, the quality of evidence is still insufficient to infer a relationship between reproductive cancers treated conservatively and adverse fetal birth outcomes in subsequent pregnancies.
Collapse
|
17
|
Franchi D, Boveri S, Fruscio R, Fischerova D, Guerriero S, Moruzzi MC, Colombo N, Timmerman D, Valentin L, Testa AC. Imaging in gynecological disease (8): ultrasound characteristics of recurrent borderline ovarian tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:452-458. [PMID: 22858859 DOI: 10.1002/uog.12276] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To describe the sonographic characteristics of borderline ovarian tumor (BOT) recurrence. METHODS From the databases of five ultrasound centers, we retrospectively identified 68 patients with histological diagnosis of recurrent BOT who had undergone preoperative ultrasound examination. All recurrences were detected during planned follow-up ultrasound examinations. Recurrent lesions were described using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. RESULTS Sixty-two patients had a serous BOT recurrence and six a mucinous BOT recurrence. All patients except one were premenopausal, 84% of them being < 40 years old. All but one patient were asymptomatic at diagnosis of the recurrence. Fertility-sparing surgery of the recurrent tumor was performed in 57/68 (84%) patients. The most frequent ultrasound feature of recurrent serous BOT was a unilocular solid cyst (49/62, 79%) and almost half of the recurrent serous BOTs (29/62, 47%) had multiple papillary projections. In 89% of the recurrent serous BOTs there was at least one papillation with irregular surface and in 73% there was at least one papillation vascularized at color Doppler examination. Recurrent mucinous BOTs appeared mainly as multilocular or multilocular solid cysts (5/6, 83%). CONCLUSION Sonographic features of recurrent BOT resemble those described by others for different subtypes of primary BOT.
Collapse
Affiliation(s)
- D Franchi
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Storms AA, Sukumvanich P, Monaco SE, Beriwal S, Krivak TC, Olawaiye AB, Kanbour-Shakir A. Mucinous tumors of the ovary: Diagnostic challenges at frozen section and clinical implications. Gynecol Oncol 2012; 125:75-9. [DOI: 10.1016/j.ygyno.2011.12.424] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022]
|
19
|
Fertility Preservation Options for Females. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 732:9-28. [DOI: 10.1007/978-94-007-2492-1_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
20
|
Eskander RN, Randall LM, Berman ML, Tewari KS, Disaia PJ, Bristow RE. Fertility preserving options in patients with gynecologic malignancies. Am J Obstet Gynecol 2011; 205:103-10. [PMID: 21411052 DOI: 10.1016/j.ajog.2011.01.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 12/26/2010] [Accepted: 01/14/2011] [Indexed: 12/23/2022]
Abstract
A proportion of reproductive age women are affected by gynecologic malignancies. This patient population is faced with difficult decisions, related to their cancer care and treatment, as well as future childbearing potential. Therefore, it is important for gynecologists to be familiar with fertility sparing management options in patients with cervical, ovarian, and endometrial cancer. In addition to understanding the surgical approaches available, providers should be able to counsel patients regarding their eligibility for and the indications and limitations of fertility sparing therapy for gynecologic cancer, allowing for appropriate referrals. A comprehensive PUBMED literature search was conducted using the key words "fertility preservation," "cervical cancer," "endometrial cancer," "ovarian cancer," "borderline tumor of the ovary," "germ cell tumor," "obstetrical outcomes," "chemotherapy," and "radiation." The following review summarizes fertility sparing options for patients with cervical, ovarian and endometrial cancer, with an emphasis on appropriate patient selection, oncologic, and obstetric outcomes.
Collapse
|
21
|
Successful extracorporeal mature oocyte harvesting after laparoscopic oophorectomy following controlled ovarian hyperstimulation for the purpose of fertility preservation in a patient with borderline ovarian tumor. J Assist Reprod Genet 2011; 28:771-2. [PMID: 21656182 DOI: 10.1007/s10815-011-9596-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 05/31/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To report the successful extracorporeal recovery of mature oocytes after laparoscopic oophorectomy following ovarian hyperstimulation for the purpose of fertility preservation in a patient with recurrent serous borderline ovarian tumor. METHODS A 25-year-old nulligravida woman presented with recurrence of a borderline serous adenocarcinoma in the right ovary after been treated conservatively with left oophorectomy for the same. RESULT(S) The patient underwent ovarian stimulation followed by a laparoscopic oophorectomy and ex-vivo retrieval of oocytes. Twenty two oocytes were recovered: fourteen metaphases II, two metaphases I, five prophases I and one degenerate. CONCLUSION(S) Mature oocytes were successfully retrieved ex-vivo from the hyperstimulated ovary recovered via laparoscopy. The procedure can be performed in a quick manner, with standard equipment, without damaging the ovary, the follicles or the oocytes, and without the risk of cancer cell spillage associated with the standard transvaginal oocyte retrieval if there is concern of ovarian surface/peritoneal metastatic disease.
Collapse
|
22
|
Song T, Hun Choi C, Lee YY, Kim TJ, Lee JW, Bae DS, Kim BG. Oncologic and reproductive outcomes of cystectomy compared with oophorectomy as a treatment for borderline ovarian tumours. Hum Reprod 2011; 26:2008-14. [DOI: 10.1093/humrep/der119] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
23
|
Fatemi HM, Kyrou D, Al-Azemi M, Stoop D, De Sutter P, Bourgain C, Devroey P. Ex-vivo oocyte retrieval for fertility preservation. Fertil Steril 2011; 95:1787.e15-7. [DOI: 10.1016/j.fertnstert.2010.11.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 09/27/2010] [Accepted: 11/09/2010] [Indexed: 10/18/2022]
|
24
|
Kanat-Pektas M, Ozat M, Gungor T, Dikici T, Yilmaz B, Mollamahmutoglu L. Fertility outcome after conservative surgery for borderline ovarian tumors: a single center experience. Arch Gynecol Obstet 2010; 284:1253-8. [PMID: 21170543 DOI: 10.1007/s00404-010-1804-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 11/30/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The present study aims to document the experience of a single center on the reproductive outcome of a cohort of women who were treated with conservative surgery for borderline ovarian tumors and to specify whether their fertility potential is associated with age, tumor histology and surgery type. METHODS A total of 55 women who had undergone conservative surgery for borderline ovarian tumors between January 1999 and January 2009 were eligible. Recurrence rate, fertility outcome and the number of pregnancies were analyzed retrospectively. RESULTS Among the study group, 11 women were not sexually active both at the time of surgery and during the follow-up period. Thus, a total of 44 patients attempted pregnancy after conservative surgery and 52.3% of them (23 out of 44) were able to conceive either spontaneously or by in vitro fertilization. The ability to conceive was shown to be associated with age, tumor histology and type of conservative surgery. As expected, the fertility potential correlated positively with decreasing age (correlation coefficient = 0.705, p = 0.001). Moreover, the existence of non-serous histology and the implementation of unilateral cystectomy were found to be associated with the ability to reach a clinical pregnancy (correlation coefficient = 0.585, p = 0.001 and correlation coefficient = 0.587, p = 0.001, respectively). CONCLUSIONS The primary treatment of borderline ovarian tumors refers to conservative surgery. Younger age, non-serous histology and unilateral cystectomy appear to be associated with favorable reproductive outcome in women who undergo conservative surgery for borderline malignancy of ovary.
Collapse
Affiliation(s)
- Mine Kanat-Pektas
- Department of Gynecologic Oncology, Dr. Zekai Tahir Burak Women Health Research and Education Hospital, Yunus Emre Mah., Dereboyu Sok. No: 71/2 Yenimahalle, 06170 Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
25
|
Kane A, Uzan C, Gouy S, Pautier P, Duvillard P, Morice P. Fertility results and outcomes after pure laparoscopic management of advanced-stage serous borderline tumors of the ovary. Fertil Steril 2010; 94:2891-4. [DOI: 10.1016/j.fertnstert.2010.04.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 04/15/2010] [Accepted: 04/16/2010] [Indexed: 11/12/2022]
|
26
|
Trillsch F, Mahner S, Ruetzel J, Harter P, Ewald-Riegler N, Jaenicke F, du Bois A. Clinical management of borderline ovarian tumors. Expert Rev Anticancer Ther 2010; 10:1115-24. [PMID: 20645700 DOI: 10.1586/era.10.90] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Borderline ovarian tumors (BOTs) are epithelial tumors of the ovaries characterized by cellular proliferation and nuclear atypia but without an infiltrative growth pattern. As they frequently affect younger patients the clinical management is complicated by considerations such as preserving fertility and reducing postoperative morbidity. Over the past several decades surgical therapy has shifted from a radical approach to more conservative treatment. There are various modes of surgery applied to the patients. All these developments have to be considered from an oncologic standpoint as BOTs represent a potentially malignant disease. Oncologic safety, as well as patients' desires and expectations, have to be balanced to reach the most appropriate treatment for BOTs. For this reason current literature will be discussed in this review to give a thorough overview of this topic and to develop recommendations for the surgical management of these patients. Open questions will be identified to elaborate the need for future surveys and research.
Collapse
Affiliation(s)
- F Trillsch
- University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | | | | | | | | | | | | |
Collapse
|
27
|
Laparoendoscopic Single-site Surgery for Fertility-sparing Staging of Border Line Ovarian Tumors. Surg Laparosc Endosc Percutan Tech 2010; 20:e172-5. [DOI: 10.1097/sle.0b013e3181f271ec] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
|
29
|
Feasibility, safety, and efficacy of conservative laparoscopic treatment of borderline ovarian tumors. Fertil Steril 2009; 92:736-41. [DOI: 10.1016/j.fertnstert.2008.07.1716] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 06/11/2008] [Accepted: 07/09/2008] [Indexed: 11/22/2022]
|
30
|
Liu CS, Nagarsheth NP, Nezhat FR. Laparoscopy and Ovarian Cancer: A Paradigm Change in the Management of Ovarian Cancer? J Minim Invasive Gynecol 2009; 16:250-62. [DOI: 10.1016/j.jmig.2009.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 12/29/2008] [Accepted: 01/08/2009] [Indexed: 11/26/2022]
|
31
|
Theodoridis TD, Zepiridis L, Mikos T, Grimbizis GF, Dinas K, Athanasiadis A, Bontis JN. Comparison of diagnostic accuracy of transvaginal ultrasound with laparoscopy in the management of patients with adnexal masses. Arch Gynecol Obstet 2009; 280:767-73. [PMID: 19263064 PMCID: PMC2751820 DOI: 10.1007/s00404-009-1001-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 02/09/2009] [Indexed: 12/01/2022]
Abstract
Purpose The aims of this study was (a) to compare the diagnostic accuracy of ultrasound examination with laparoscopic findings and both with the gold standard (histology) in the management of benign ovarian lesions, and (b) to assess the feasibility of laparoscopy in their diagnosis and management. Methods Prospective, comparative study (Canadian Task Force Classification II-2). A total of 117 women 15–59 years old were examined at outpatient department and had transvaginal ultrasound assessment. Ninety-eight women (three postmenopausal) with 105 cystic ovarian lesions met inclusion criteria and underwent operative laparoscopy. Histology was performed in all cases. Results Although laparoscopy showed an overall higher performance compared to transvaginal ultrasound, statistically significant difference was found only in the detection of endometriomas compared to ultrasound (P = 0.004 for sensitivity and P = 0.046 for specificity). Conclusion Laparoscopy exhibits higher diagnostic accuracy, especially in endometriomas, compared to transvaginal scan. Laparoscopic diagnosis appears to be safe and accurate. Conservative laparoscopic management of benign adnexal masses is safe and with low morbidity.
Collapse
Affiliation(s)
- Theodoros D Theodoridis
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | | | | | | | | | | | | |
Collapse
|
32
|
Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH. Surgical management of borderline ovarian tumors: The role of fertility-sparing surgery. Gynecol Oncol 2009; 113:75-82. [PMID: 19171373 DOI: 10.1016/j.ygyno.2008.12.034] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 12/14/2008] [Accepted: 12/20/2008] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the recurrence, survival, and pregnancy outcomes of patients with borderline ovarian tumors (BOT) treated with fertility-sparing surgery. METHODS The medical records of patients with BOT who underwent surgery between 1989 and 2008 were retrospectively reviewed. Outcomes were compared between groups that underwent radical or fertility-sparing surgery. Fertility-sparing surgery was defined as the preservation of the uterus and ovarian tissue in one or both adnexa. RESULTS During the study period, 360 patients with BOT were identified; of these, 344 had stage I, one had stage II, and 15 had stage III disease. A total of 176 patients underwent radical surgery (23 laparoscopically and 153 laparotomically), and 184 underwent fertility-sparing surgery (48 laparoscopically and 136 laparotomically). After surgery, 45 patients received adjuvant chemotherapy. After a median follow-up time of 70 months (range, 3-216 months), 18 patients had recurrent disease and 5 died of disease. The recurrence rate was similar in the radical and fertility-sparing surgery groups (4.9% vs. 5.1%, p=0.923). In the fertility-sparing surgery group, however, the most common site of recurrence was the remaining ovarian tissue which was successfully salvaged with a second round of fertility-sparing surgery. Multivariate analysis showed no difference in disease-free survival between groups that underwent radical or fertility-sparing surgery (p=0.651). To date, there have been 34 full-term deliveries by women in the fertility-sparing surgery group. CONCLUSIONS Fertility-sparing surgery for patients with BOT is safe and can permit future pregnancy, suggesting that such surgery should be considered for young patients who wish to preserve fertility.
Collapse
Affiliation(s)
- Jeong-Yeol Park
- Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center, #388-1 Poongnap-2 dong, Songpa-gu, Seoul, 138-736, Republic of Korea
| | | | | | | | | | | |
Collapse
|
33
|
Swanton A, Bankhead CR, Kehoe S. Pregnancy rates after conservative treatment for borderline ovarian tumours: a systematic review. Eur J Obstet Gynecol Reprod Biol 2008; 135:3-7. [PMID: 17983919 DOI: 10.1016/j.ejogrb.2007.05.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Revised: 05/14/2007] [Accepted: 05/24/2007] [Indexed: 11/28/2022]
Abstract
Borderline ovarian tumours account for 10-15% of all ovarian cancers, and there have been numerous studies indicating their excellent long-term prognosis. As this disease commonly affects younger women, the issue of fertility-preserving surgery is increasingly important. A systematic review of the literature, searching the relevant electronic databases was performed analysing conservative surgery, borderline ovarian tumours and pregnancy rates/fertility outcome. Overall, 19 studies met the inclusion criteria. From these studies, 2479 patients had borderline ovarian tumours of which 923 (37%) patients were treated by conservative surgery. Nine studies recorded data regarding pregnancy outcome. A pregnancy rate of 48% was calculated on these data, where recorded, analysing the number of women wanting to conceive and the actual number of pregnancies achieved. The recurrence rate after conservative treatment was 16% with only five recorded disease-related deaths. Knowledge of the pregnancy rates is important to permit appropriate counselling of women diagnosed with this malignancy.
Collapse
Affiliation(s)
- Alexander Swanton
- Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom
| | | | | |
Collapse
|
34
|
Porcu E, Venturoli S, Damiano G, Ciotti PM, Notarangelo L, Paradisi R, Moscarini M, Ambrosini G. Healthy twins delivered after oocyte cryopreservation and bilateral ovariectomy for ovarian cancer. Reprod Biomed Online 2008; 17:265-7. [DOI: 10.1016/s1472-6483(10)60204-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
35
|
Park CW, Yang KM, Kim HO, Hong SR, Kim TJ, Lim KT, Lee KH, Kang IS. Outcomes of controlled ovarian hyperstimulation/in vitro fertilization for infertile patients with borderline ovarian tumor after conservative treatment. J Korean Med Sci 2007; 22 Suppl:S134-8. [PMID: 17923740 PMCID: PMC2694376 DOI: 10.3346/jkms.2007.22.s.s134] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To evaluate the outcomes of controlled ovarian hyperstimulation (COH)-in vitro fertilization (IVF) such as clinical pregnancy rate (CPR), implantation rate (IR) and live birth rate (LBR) for infertile patients with borderline ovarian tumor (BOT) after conservative treatment, 10 IVF cycles in five patients from January 1999 to July 2005 were analyzed. At the time of diagnosis with BOT, the mean age of patients was 30.0 yr (range, 22-40). For 8 cycles out of 10 attempted IVF cycles, except for 2 cancellation cycles, the mean number of oocytes retrieved was 5.6 (range, 2-16) with a mean fertilization rate of 74.4%. The CPR, IR, and LBR were 50.0% (4/8 cycles), 31.6% (6/19) and 50.0% (4/8 cycles) respectively. The mean follow-up period after COH-IVF initiation was 29.6 (range, 14-61) months. A gynecological oncologist followed all patients every 3 months during the first year and every 6 months thereafter. There was no recurrence during the follow-up period. Our results suggest that COH-IVF may be acceptable for infertile patients with BOT, especially in patients with early-stage BOT after conservative treatment.
Collapse
Affiliation(s)
- Chan Woo Park
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Cadron I, Leunen K, Van Gorp T, Amant F, Neven P, Vergote I. Management of borderline ovarian neoplasms. J Clin Oncol 2007; 25:2928-37. [PMID: 17617524 DOI: 10.1200/jco.2007.10.8076] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Over the last decades, the management of borderline ovarian tumors (BOTs) has changed from radical surgery to more conservative therapy as a result of the need for fertility-sparing surgery and the increasing use of laparoscopy. The question is whether this is good clinical practice from an oncologic point of view. Here, recent literature regarding management of borderline ovarian neoplasms is reviewed, and oncologic concerns are discussed with emphasis on the mode of surgery and the possibility of fertility-sparing surgery and its consequences. Proper staging is defined as an exploration of the entire abdominal cavity with peritoneal washings, infracolic omentectomy, and multiple peritoneal biopsies as the cornerstone of a successful treatment, and this is only possible through a midline incision. For stage I disease, conservative surgery consisting of unilateral salpingo-oophorectomy or cystectomy in case of bilateral ovarian involvement or when the disease develops in the only remaining ovary is a valuable alternative in a number of young patients who want to preserve their fertility. Patients with advanced-stage disease or who are finished childbearing are treated with radical surgery consisting of peritoneal washings, total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, complete peritoneal resection of macroscopic lesions, or multiple peritoneal biopsies; in case of mucinous BOTs, patients also are treated with an appendectomy.
Collapse
Affiliation(s)
- Isabelle Cadron
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
37
|
Daraï E, Tulpin L, Prugnolle H, Cortez A, Dubernard G. Laparoscopic restaging of borderline ovarian tumors. Surg Endosc 2007; 21:2039-43. [PMID: 17514402 DOI: 10.1007/s00464-007-9286-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2006] [Accepted: 01/28/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to evaluate the feasibility and relevance of laparoscopic restaging surgery for women with borderline ovarian tumors. METHODS From March 2001 to February 2006, 42 women referred for borderline ovarian tumors after laparoscopy or laparotomy underwent a laparoscopic restaging operation. Of these women, 37 (88%) had undergone conservative surgery including unilateral cystectomy (n = 16), bilateral cystectomy (n = 1), and unilateral salpingo-oophorectomy (n = 20). The remaining five women (12%) had undergone radical surgery, including bilateral salpingo-oophorectomy (BSO) (n = 4) and hysterectomy with BSO (n = 1). Intraoperative rupture occurred in 13 cases. RESULTS All 42 restaging operations were performed via the laparoscopic approach. There were no intraoperative complications, no laparoconversions, and no postoperative complications. Laparoscopic restaging identified two persistent borderline ovarian tumors (12%) in women who had initially undergone cystectomy. Seven women were upstaged (16.6%) because of positive cytology (n = 2), peritoneal biopsy (n = 2), or omentum (n = 3). Among the 28 women with initial Federation International of Gynaecology and Obstetrics (FIGO) stage Ia disease, the final stage was Ia for 24 women, Ib for 2 women, IIIa for 1 woman, and IIIc for 1 woman. Among the 12 women with initial stage Ic disease, 11 kept the same stage and 1 was upstaged to IIIc. The woman with initial stage IIa disease was upstaged to IIb, and the woman with initial stage IIc disease was upstaged to IIIc. The risk of upstaging was significantly higher among women with serous borderline tumors. Upstaging occurred in women with both initial stages I and II disease. CONCLUSIONS The results confirm the feasibility and safety of laparoscopic restaging operations for women with borderline ovarian tumors. Cystectomy was associated with a risk of persistent lesions. The risk of upstaging was higher for women with serous borderline ovarian tumors and women with initial FIGO stage I or II disease.
Collapse
Affiliation(s)
- E Daraï
- Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
| | | | | | | | | |
Collapse
|
38
|
Clinical outcome of cystectomy compared with unilateral salpingo-oophorectomy as fertility-sparing treatment of borderline ovarian tumors. Fertil Steril 2007; 88:479-84. [PMID: 17408624 DOI: 10.1016/j.fertnstert.2006.11.128] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Revised: 11/21/2006] [Accepted: 11/21/2006] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare recurrence rates and fertility outcomes of patients with borderline ovarian tumors (BOTs) who underwent unilateral salpingo-oophorectomy with those of patients who underwent cystectomy only. DESIGN Retrospective study. SETTING Gynecologic oncology department of a tertiary center. PATIENT(S) Sixty-two patients with BOTs who underwent fertility-preserving surgery. INTERVENTION(S) Unilateral salpingo-oophorectomy (USO, n = 40) or cystectomy only (n = 22). MAIN OUTCOME MEASURE(S) Tumor recurrence rate, incidence of pregnancy. RESULT(S) All 62 patients were alive with no clinical evidence of disease after a mean follow-up of 88 months. There was no statistically significant difference in mean tumor recurrence rates between patients who had undergone cystectomy only and those who had undergone USO (22.7% and 27.5%, respectively). In the cystectomy-treated group, the disease-free interval was shortened (23.6 compared with 41 mo), but the difference was not significant. However, the mean follow-up period for the cystectomy group was significantly shorter than for the USO group. Of the 62 patients, 25 (40.3%) attained 38 pregnancies, resulting in 35 deliveries. CONCLUSION(S) Our results support previous findings that conservative surgery is an acceptable option for women with BOTs who wish to preserve fertility. Cystectomy, like oophorectomy, appears to be an adequate treatment, provided that the patient is willing to undergo careful and prolonged follow-up.
Collapse
|
39
|
Maltaris T, Boehm D, Dittrich R, Seufert R, Koelbl H. Reproduction beyond cancer: A message of hope for young women. Gynecol Oncol 2006; 103:1109-21. [PMID: 16996582 DOI: 10.1016/j.ygyno.2006.08.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Revised: 07/19/2006] [Accepted: 08/04/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Aggressive chemotherapy and radiotherapy or radical oncological surgery in young women with cancer has greatly enhanced these patients' life expectancy, but these treatments often cause infertility or premature ovarian failure due to a massive destruction of the ovarian reserve. The objective of this review is to discuss the effect of the various cancer treatments on fertility and present the various fertility sparing operations and fertility preservation strategies. METHOD An extensive survey of the most up-to-date literature was performed. RESULTS This review discusses the impact of current cancer treatment on fertility potential and the various surgical and assisted-reproduction innovations available today for the most common cancers in young women. Although the ability to retain reproductive potential is becoming a major quality-of-life factor in an increasing number of young female cancer survivors, they are still being poorly counseled with regard to the negative impact of the treatment on their fertility and on their options for fertility preservation. CONCLUSION As the emerging discipline of fertility preservation is steadily attracting increasing interest, developments in the near future promise to be very exciting. However, in everyday routine work, better interdisciplinary cooperation between gynecological and pediatric oncologists, surgeons, immunologists, and endocrinologists is necessary so that individualized options for fertility preservation can be offered in advance of surgical procedures or cancer treatments.
Collapse
Affiliation(s)
- Theodoros Maltaris
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Mainz University Hospital, Langenbeckstrasse 1, 55124 Mainz, Germany.
| | | | | | | | | |
Collapse
|
40
|
Palomba S, Zupi E, Russo T, Falbo A, Del Negro S, Manguso F, Marconi D, Tolino A, Zullo F. Comparison of two fertility-sparing approaches for bilateral borderline ovarian tumours: a randomized controlled study. Hum Reprod 2006; 22:578-85. [PMID: 17050549 DOI: 10.1093/humrep/del381] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND During the childbearing years, the standard fertility-sparing treatment for bilateral borderline ovarian tumours (BOTs) is the unilateral oophorectomy plus controlateral cystectomy. The aim of the present study was to compare the effects of two laparoscopic fertility-sparing surgical procedures for the treatment of bilateral BOTs on recurrence and fertility in young women who desire to conceive as soon as possible. METHODS Thirty-two women affected by bilateral early-stage BOTs who desired to conceive were randomized to receive bilateral cystectomy (experimental group, n=15) or oophorectomy plus controlateral cystectomy (control group, n=17). At the first recurrence after childbearing completion, each patient was treated with non-conservative standard treatment. Recurrences and reproductive events were recorded. RESULTS After a follow-up period of 81 months (19 inter-quartile; 60-96 range), the cumulative pregnancy rate (CPR) (14/15 versus 9/17; P=0.003) and the cumulative probability of first pregnancy (P= 0.011) were significantly higher in the experimental than in control group. No significant (P=0.358) difference between groups was detected in cumulative probability of first recurrence. CONCLUSIONS The laparoscopic bilateral cystectomy followed by non-conservative treatment performed at the first recurrence after the childbearing completion is an effective surgical strategy for patients with bilateral early-stage BOTs who desire to conceive as soon as possible.
Collapse
Affiliation(s)
- S Palomba
- Department of Obstetrics and Gynecology, University Magna Graecia of Catanzaro, Catanzaro, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Cadron I, Amant F, Van Gorp T, Neven P, Leunen K, Vergote I. The management of borderline tumours of the ovary. Curr Opin Oncol 2006; 18:488-93. [PMID: 16894298 DOI: 10.1097/01.cco.0000239889.98289.ce] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The treatment of borderline ovarian tumours has been similar to that for their invasive counterparts for a long time. However, in view of the good prognosis for borderline ovarian tumours, their occurrence in a younger age group and the development of less invasive techniques, the question can be asked as to whether a more conservative treatment is warranted. RECENT FINDINGS Recent articles discuss the mode of surgery (laparotomy or laparoscopy), the possibility of fertility-sparing surgery, the need for restaging procedures and adjuvant therapy. SUMMARY The ultimate goal in treating patients with borderline ovarian cancer is defining those patients with bad prognostic factors and risk for recurrence and who consequently require more aggressive therapy. A proper staging procedure is crucial to estimate the risk. Translational research might help identify borderline tumours with poor prognosis. Fertility-sparing surgery is often a good option in young patients with Fédération International de Gynécologie et Obstétrie (FIGO) stage I disease or in selected cases with noninvasive implants, since long-term survival does not seem to be negatively influenced by conservative surgery.
Collapse
Affiliation(s)
- Isabelle Cadron
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Katholieke Universiteit Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
42
|
Fauvet R, Poncelet C, Daraï E. Faisabilité et limites du traitement cœlioscopique des tumeurs frontières de l'ovaire. ACTA ACUST UNITED AC 2006; 34:470-8. [PMID: 16677839 DOI: 10.1016/j.gyobfe.2006.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Accepted: 03/28/2006] [Indexed: 01/15/2023]
Abstract
Borderline ovarian tumours (BOT) are mainly diagnosed in young women with early stage disease. Due to the absence of specific pre operative criteria for BOT, a laparoscopy is usually performed. A review of the literature found no pejorative data on laparoscopic approach for BOT. Strict surgical procedures must be performed to avoid incomplete surgical staging, cells dissemination and port-site metastases. The limits of the laparoscopic management are the stage of disease and the tumour size. Laparoscopic treatment of BOT for women with early stage disease is feasible. This treatment should be evaluated in specialized centres for women with advanced stage diseases and/or peritoneal implants.
Collapse
Affiliation(s)
- R Fauvet
- Service de gynécologie--obstétrique, CHI Poissy--Saint-Germain-en-Laye, Poissty, France
| | | | | |
Collapse
|
43
|
Zanagnolo V, Sartori E, Trussardi E, Pasinetti B, Maggino T. Preservation of ovarian function, reproductive ability and emotional attitudes in patients with malignant ovarian tumors. Eur J Obstet Gynecol Reprod Biol 2006; 123:235-43. [PMID: 15921842 DOI: 10.1016/j.ejogrb.2005.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Revised: 03/11/2005] [Accepted: 04/26/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although cancer is predominantly a disease of aging, an increasing number of women survive malignancies before or during their reproductive years, which may interfere with their fertility potential. Although a variety of studies have tried to document the impact of conservative treatment aimed at preserving ovarian function and reproductive ability, little information has been available regarding survivors' attitudes, emotions, and choices to have children. The aim of this study is to evaluate the reproductive history, experiences, attitudes, and emotions with regard to having children in conservatively treated patients with Stage I epithelial ovarian cancer, any stage LMP tumors, malignant ovarian germ cell tumors (MOGCTs) and Stage I sex cord-stromal tumors (SCSTs). STUDY DESIGN Between 1986 and 2000, a total of 75 patients with primary malignant ovarian tumors underwent conservative treatment. Out of 75 patients in the study, 14 women (19%) presented Stage I epithelial ovarian cancer, 23 (31%) LMP tumors, 33 (43%) MOGCTs, and five (7%) SCSTs. Information was obtained from medical records and from a questionnaire mailed to all patients who were at least 15 years old at the time of the diagnosis (68 subjects). Median time of follow-up was 102 months (35-192 months). There were four (5.2%) clinical recurrences within 35 months. Only 20 patients (49%) had tried to conceive after the completion of their treatment; of these, 15 women (75%) succeeded and delivered 19 healthy children. Seventy percent (32/41) of the respondents claimed that their disease did not have any impact on their desire to have children. Whereas 51% (21/41) fear that their ovarian disease could have damaged their reproductive potential, 76% (31/41) are not concerned about the effects of the treatment they received on offspring. The impact of the disease on the patients' attitudes toward life was reported as positive. CONCLUSION The results from our study, in agreement with the data from the literature, confirm that management of Stage I (grade 1, grade 2) epithelial ovarian cancer, any stage LMP tumors, MOGCTs and Stage I SCSTs with fertility-sparing surgery is a safe, practicable treatment option. Though preliminary, this survey provides insight into the attitudes and experiences of young women ovarian cancer survivors regarding fertility.
Collapse
Affiliation(s)
- Vanna Zanagnolo
- Institute of Obstetrics and Gynecology, University of Brescia, Italy
| | | | | | | | | |
Collapse
|
44
|
Poncelet C, Fauvet R, Boccara J, Daraï E. Recurrence after cystectomy for borderline ovarian tumors: results of a French multicenter study. Ann Surg Oncol 2006; 13:565-71. [PMID: 16491337 DOI: 10.1245/aso.2006.12.024] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Accepted: 10/12/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Fertility-sparing surgery for borderline ovarian tumors (BOT) is feasible and effective and does not seem to have a negative effect on survival. Specific data on the effect of cystectomy, and notably on recurrence, are lacking. METHODS This was a French retrospective multicenter study of 313 women with stage I BOT treated from 1990 to 2000 in 13 specialized gynecological units and 1 cancer center. Diagnosis and staging were based on International Federation of Gynecology and Obstetrics (1989) criteria. Surgery consisted of cystectomy, unilateral salpingo-oophorectomy (USO), or bilateral salpingo-oophorectomy (BSO). RESULTS After cystectomy, persistent BOT and benign ovarian cysts on the operated ovary were observed in 15% and 65% of patients, respectively. Mean follow-up did not differ among patients receiving the three types of surgery. The recurrences after cystectomy, USO, and BSO treatment were 30.3%, 11%, and 1.7%, respectively (P<.0001). Recurrences were more frequent after cystectomy than after USO (P=.0001) and BSO (P=.0001) and when intraoperative cyst rupture occurred (P=.04). CONCLUSIONS These results suggest that cystectomy for BOT is associated with a high risk of intraoperative cyst rupture and of recurrence compared with USO or BSO.
Collapse
Affiliation(s)
- Christophe Poncelet
- Service de Gynécologie-Obstétrique, Hôpital Tenon, AP-HP, 4 Rue de la Chine, CancerEst, UFR Saint-Antoine, Paris VI, 75020, France
| | | | | | | |
Collapse
|
45
|
Morice P. Borderline tumours of the ovary and fertility. Eur J Cancer 2005; 42:149-58. [PMID: 16326097 DOI: 10.1016/j.ejca.2005.07.029] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Accepted: 07/27/2005] [Indexed: 11/29/2022]
Abstract
Standard management of borderline ovarian tumours (BOT) is historically radical and based on hysterectomy, bilateral salpingo-oophorectomy and peritoneal staging. But, as 1/3 of BOTs are diagnosed in patients aged less than 40 years, treatments preserving fertility-potential (with preservation of the uterus and at least part of one ovary) has seen great developments in the last decade. Such treatments increase the rate of recurrences (between 15% and 35% depending on the type of conservative surgery), but without any impact on patient survival as most recurrent diseases are of the borderline type, easily curable and with excellent prognosis. The spontaneous pregnancy rate is nearly 50%. In case of persistent infertility, it seems that the use of ovarian induction or in vitro fertilization procedures could be proposed in selected cases. Follow-up is essential and based on clinical examination and routine ultrasonography. The interest of completion surgery (removal of the retained ovary) in patients who obtained pregnancy remains debated. In conclusion, conservative management of at least part of one ovary and uterus could be safely proposed at least to patients with early stage BOT, in order to preserve fertility-potential. The rate of recurrence is increased but without any impact on survival.
Collapse
Affiliation(s)
- P Morice
- Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France.
| |
Collapse
|
46
|
Abstract
Ovarian tumors during pregnancy are very rare; however, a cancer diagnosis causes distress to the couple. Reassurance is paramount, and the first consideration should be given to the safety of the mother. If both mother and fetus can be preserved, treatment to minimize the risks to both should be planned accordingly. It is imperative to care for the patient with a multidisciplinary team that includes a high-risk obstetrician, a gynecologic oncologist, and a medical oncologist specialized in gynecologic cancers.
Collapse
Affiliation(s)
- Hamid Sayar
- Cancer Research and Treatment Center, Division of Hematology Oncology, University of New Mexico, 900 Camino de Salud NE, Albuquerque, NM 87131, USA.
| | | | | |
Collapse
|
47
|
Romagnolo C, Gadducci A, Sartori E, Zola P, Maggino T. Management of borderline ovarian tumors: results of an Italian multicenter study. Gynecol Oncol 2005; 101:255-60. [PMID: 16307793 DOI: 10.1016/j.ygyno.2005.10.014] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 10/07/2005] [Accepted: 10/14/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A rising number of patients affected by ovarian masses suspected of borderline ovarian tumor are operated on primary laparoscopic procedure. METHODS From January 1992 to June 2004, 113 patients affected by low malignant ovarian tumor were followed at the Gynecologic Departments of five Italian Institutions. Fifty-two (46.0%) patients were operated on laparoscopic surgery, whereas traditional laparotomic approach was preferred in 61 cases (54%). In 53 patients (46.9%), a fertility-sparing surgical treatment was chosen. RESULTS The diameter of the ovarian cysts ranged between 20 and 300 mm; in 20 out 113 patients (17.7%), the borderline tumor was bilateral. In 22/113 (19.5%) cases, we observed tumor rupture or spilling during surgery, and this incidence was greater in the group of patients treated by laparoscopy compared to laparotomy, and this difference is statistically significative. In 13/113 (11.5%) patients, we observed a relapse; the incidence of relapse, however, is not dependent on the type of surgical approach. The progression-free survival is higher for stages IA-IC if compared to stages more than Ist and the difference is statistically significant. Type of surgical approach, laparoscopic versus laparotomic, does not seem to influence the PFS; when cystectomy is performed, the PFS is significantly lower if compared with demolitive surgery or monolateral annessectomy. Eight pregnancies were obtained: in one case, miscarriage was observed, whereas 7 healthy babies were born all but two by vaginal delivery. CONCLUSIONS Conservative laparoscopic surgery may be the treatment of choice; an attractive option is that this surgery should be performed by an oncologist surgeon to obtain correct surgical staging and better results in terms of both relapse-free survival and pregnancies.
Collapse
Affiliation(s)
- Cesare Romagnolo
- Department of Gynecology, Sacro Cuore Hospital, V.le Sempreboni, 37024 Negrar (Verona), Italy.
| | | | | | | | | |
Collapse
|
48
|
Tinelli R, Tinelli A, Tinelli FG, Cicinelli E, Malvasi A. Conservative surgery for borderline ovarian tumors: a review. Gynecol Oncol 2005; 100:185-91. [PMID: 16216320 DOI: 10.1016/j.ygyno.2005.09.021] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Revised: 09/07/2005] [Accepted: 09/12/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Borderline tumor of the ovary is an epithelial tumor with a low rate of growth and a low potential to invade or metastasize. This review will outline the most recent information regarding the molecular pathogenesis, pathology, fertility and tumor recurrence rate after conservative management of young women with early-stage borderline ovarian tumors. METHODS We performed a MEDLINE literature search of relevant clinical trials for the scope of this review that evaluated conservative treatment of borderline ovarian tumors for young women with low-stage disease who wish to preserve their fertility. RESULTS Recently, investigators have begun to identify subsets of patients with a worse prognosis, such as patients with aneuploid tumors. A number of oncogenes are under investigation to determine their role in the pathogenesis of borderline ovarian tumors. Previous studies have suggested the safety of conservative surgery with unilateral salpingo-oophorectomy or cystectomy for patients with stage I borderline ovarian tumors. Laparoscopic treatment of adnexal masses has proved to be a safe and effective diagnostic and therapeutic tool in the hands of experienced laparoscopists. For women who are treated conservatively, follow-up is important. Surgery remains the most effective therapy for later stage lesions. Adjuvant therapy for advanced stage of borderline ovarian tumors remains controversial. CONCLUSION Conservative management of borderline ovarian tumors is an appropriate therapeutic option for young women with early-stage lesions who wish to preserve their childbearing potential. Available data indicate that in these patients fertility, pregnancy outcome and survival remain excellent.
Collapse
Affiliation(s)
- Raffaele Tinelli
- I Department of Obstetrics and Gynecology, University Medical School of Bari, Piazza Giulio Cesare, Bari, Italy.
| | | | | | | | | |
Collapse
|
49
|
Boran N, Cil AP, Tulunay G, Ozturkoglu E, Koc S, Bulbul D, Kose MF. Fertility and recurrence results of conservative surgery for borderline ovarian tumors. Gynecol Oncol 2005; 97:845-51. [PMID: 15896834 DOI: 10.1016/j.ygyno.2005.03.010] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Revised: 03/03/2005] [Accepted: 03/09/2005] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the fertility and recurrence outcomes in women treated with fertility-sparing surgery for borderline ovarian tumors. METHODS A total of 142 patients with borderline ovarian tumors managed surgically from 1993 to 2004 were identified from gynecologic oncology and pathology files of SSK Ankara Maternity and Women's Health Teaching Hospital. Sixty-two of those patients who had conservative surgery were eligible for the study. Information was acquired by retrospective medical record review and patient interview. RESULTS The observed recurrence rates after radical and fertility-sparing surgery were 0.0% and 6.5%, respectively. Four patients from the conservative surgery group developed recurrence, in contrast to none of the patients from the non-conservative surgery group. No disease-related deaths occurred in any group. In the conservatively managed group, ten women had successful pregnancies, with a total of 10 live births and 3 abortions. The mean duration of follow-up for the conservative surgery group was 44.3 months (range, 3-128). CONCLUSION Fertility-sparing surgery for borderline ovarian tumors should be considered for women in the reproductive age group who desire preservation of fertility. Recurrence is noted significantly more often after this type of treatment and close follow-up is needed to detect recurrent disease.
Collapse
Affiliation(s)
- Nurettin Boran
- SSK Ankara Maternity and Women's Hospital, Department of Gynecologic Oncology, Etlik, Ankara 06100, Turkey
| | | | | | | | | | | | | |
Collapse
|
50
|
Camatte S, Deffieux X, Castaigne D, Thoury A, Fourchotte V, Pautier P, Lhommé C, Duvillard P, Morice P. Traitement cœlioscopique des tumeurs frontières (borderline) de l'ovaire : analyse d'une série de 54 patientes et implications thérapeutiques. ACTA ACUST UNITED AC 2005; 33:395-402. [PMID: 15927503 DOI: 10.1016/j.gyobfe.2005.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Accepted: 04/29/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study is to assess the clinical outcomes of laparoscopic treatment of borderline ovarian tumor (BOT). PATIENTS AND METHODS Retrospective analysis of 54 patients treated using a laparoscopic approach for a BOT between January 1984 and January 2002. RESULTS A conservative management was initially performed in 45 patients (83%). Twenty-six patients underwent a reassessment surgery and 7 (27%) of them were upstaged following this procedure. Seven (13%) patients recurred in a remaining ovary following conservative surgery (5 patients) or on the peritoneum (2 patients). Three port-site localizations were observed. None of the patients treated with conservative management had recurrent disease under the form of ovarian carcinoma. Nine spontaneous pregnancies were observed in 6 patients from a group of 19 patients desiring pregnancy. All patients are today alive and disease-free. DISCUSSION AND CONCLUSION Our study suggests that laparoscopic treatment could be safely performed in young patients with early stage BOT. Such procedure should be further evaluated in patients with BOT and peritoneal implants.
Collapse
Affiliation(s)
- S Camatte
- Service de chirurgie, institut Gustave-Roussy, Villejuif, France
| | | | | | | | | | | | | | | | | |
Collapse
|