[Prognosis and fertility after conservative treatment for ovarian tumors of limited malignity: review of 68 cases].
The aim of this retrospective study was to evaluate the rate of recurrence and the reproductive outcome after surgical conservative treatment of low malignant ovarian tumors (LMOT).


METHODS
Sixty-eight patients with 50 Stage I LMOT and 18 LMOT with peritoneal implants treated conservatively at institut Gustave-Roussy, between January 1969 and December 2000. Fifty-nine patients had an unilateral adnexectomy (associated twelve times with a contralateral cystectomy), Seven had a bilateral cystectomy and two an unilateral cystectomy. Five patients received adjuvant therapy.


RESULTS
With a median follow-up of 71.5 months, 16 patients recurred and one had evolutive peritoneal disease. The histologic pattern of ovarian recurrences was always of borderline type. The histologic patterns of peritoneal recurrence was similar to those initially diagnosed except in one case. Peritoneal implants, exophytic tumor and serous type tumor were significatively associated with a higher 5-year recurrence rate. Recurrence was more frequent after cystectomy than unilateral adnexectomy (p = 0.13). None of patients treated conservatively recurred under the form of ovarian carcinoma. None patient died of tumor. Nineteen patients experienced 26 pregnancies: 24 were spontaneous in a median delay of 19 months. Seven infertile patients underwent ovarian stimulation. None recurred after infertility treatments. The 2-year and 5-year cumulative pregnancy rate were respectively 41.9% and 59.8%. Four patients experienced a pregnancy after a conservative treatment of their recurrence.


CONCLUSIONS
Despite a high recurrence rate, especially in stage II and III serous LMOT, conservative treatment of LMOT does not affect survival and should be considered in young patients. Such treatment is not advised in case of invasive peritoneal implants. Spontaneous pregnancy rate is good but the frequent infertility associated with these tumors can afterwards require ovarian stimulation. Limited number of stimulation cycles is acceptable in such patients.
Camatte
S
S
Service de chirurgie oncologique-gynécologique, Institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif, France.
Rouzier
R
R
Boccara-Dekeyser
J
J
Pautier
P
P
Pomel
C
C
Lhomme
C
C
Duvillard
P
P
Castaigne
D
D
Morice
P
P
D000290:Adnexa Uteri / Q000601:surgery; D000293:Adolescent; D000328:Adult; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D008197:Lymph Node Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010048:Ovarian Cysts / Q000601:surgery; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D010537:Peritoneum / Q000473:pathology; D011247:Pregnancy; D011379:Prognosis; D016896:Treatment Outcome