title: [Multicenter randomized controlled clinical study for the operative treatment of malignant ovarian germ cell tumors].
abstract: OBJECTIVE
  To investigate the operative treatment for first-treated patients with malignant ovarian germ cell tumors who need preservation of fertility.
  
  
  METHODS
  The clinical data of 105 patients who were treated with fertility-sparing surgery in 11 hospitals from 1992 to 2010 were collected to evaluate the outcomes of different primary surgical operative procedures. All 105 cases were performed the surgeries that preserved fertility and divided into three groups according to the surgical approaches, comprehensive staging surgery group: 47 cases (44.8%) received comprehensive staging surgeries that including the ipsilateral oophorectomy + omentectomy + retropertoneal lymph node dissection ± appendectomy + multiple biopsies;oophorectomy group:45 cases (42.9%)received ipsilateral oophorectomy ± biopsy of contralateral ovary ± omentectomy;tumor resection group:13 cases (12.4%) received enucleation of the mass with preservation of the ovary. Differences were compared among the three groups of patients in the surgery-related indicators, complications, fertility and prognosis.
  
  
  RESULTS
  (1) Surgery-related indicators:the average blood loss of the comprehensive staging surgery group, the oophorectomy group and the tumor resection group were 496, 104 and 253 ml, the mean operation time were 176, 114 and 122 minutes, respectively, and there were significant differences among three groups (P = 0.011, P = 0.000). (2) Complication:the surgical complication rates of the three groups were 17% (8/47), 0 and 1/13, with significant differences (P = 0.015). (3) Reproductive function status: the pregnancy rate and birth rate of the three groups were no significant differences (9/19 vs. 7/19 vs. 2/3, P = 0.515; 8/19 vs. 5/19 vs. 2/3, P = 0.636). (4) PROGNOSIS: the recurrence rate of the three groups were significant differences [13% (6/47) vs. 0 vs. 2/13, P = 0.013], but the death rate with no significant differences [6% (3/47) vs. 0 vs. 0, P = 0.129]; The five-year survival rate of three different groups were 89%, 100% and 100% (P > 0.05), while disease free survival rate were 85%, 100% and 83% (P < 0.05), respectively.
  
  
  CONCLUSIONS
  Compared with comprehensive staging surgery, oophorectomy group have higher surgical security and satisfactory prognosis, considerable pregnancy rates and birth rate. The tumor resection security may be reliable, but the prognosis is poor.
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Liu
authors.forename: Xi-lai
authors.initials: XL
authors.lastname: Ding
authors.forename: Jia-xin
authors.initials: JX
authors.lastname: Yang
authors.forename: Dong-yan
authors.initials: DY
authors.lastname: Cao
authors.forename: Keng
authors.initials: K
authors.lastname: Shen
authors.forename: Jing-he
authors.initials: JH
authors.lastname: Lang
authors.forename: Guo-nan
authors.initials: GN
authors.lastname: Zhang
authors.forename: Xiao-yan
authors.initials: XY
authors.lastname: Xin
authors.forename: Xing
authors.initials: X
authors.lastname: Xie
authors.forename: Shu-lan
authors.initials: SL
authors.lastname: Zhang
authors.forename: Yu-mei
authors.initials: YM
authors.lastname: Wu
authors.forename: Gen-hai
authors.initials: GH
authors.lastname: Zhu
authors.forename: Jia
authors.initials: J
authors.lastname: Wang
authors.forename: Yi-le
authors.initials: YL
authors.lastname: Chen
authors.forename: Bei-hua
authors.initials: BH
authors.lastname: Kong
authors.forename: Jian-hua
authors.initials: JH
authors.lastname: Zheng
mesh_terms: D000293:Adolescent; D000328:Adult; D001707:Biopsy, Needle; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D059247:Fertility Preservation; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009852:Omentum / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult