Fertility-sparing surgery in ovarian cancer: a systematic review.
BACKGROUND
Ovarian cancer is rarely diagnosed in women of reproductive age; however, this coincidence seems to increase due to changes in lifestyle. Available evidence on the prognostic impact of fertility-sparing surgery (FSS) is sparse, and there is an emerging need to consolidate such evidence.


METHODS
Systematic review of the literature, including testing for heterogeneity and meta-analytical odds ratio (OR) calculations.


RESULTS
15 studies comprising 913 patients met the inclusion criteria for this review. Out of the 913 patients undergoing FSS, 11.4% developed recurrence during observation. Stage IB/C tumors were nearly twice as likely to recur as stage IA tumors (OR 1.72, 95% confidence interval (CI) 1.12-2.64, p < 0.05), and the risk of recurrence was 4 times higher in G2/3 compared to G1 tumors (4.26, 95% CI 2.31-7.86, p < 0.0001; and stage IC/G2/3 vs. stage IC/G1: OR 2.04, 95% CI 0.86-4.85, p > 0.05). A non-significant risk elevation was attributed to stage IC/G1 compared to stage IA/G1 (OR 1.48, 95% CI 0.66-3.16, p > 0.05).


CONCLUSIONS
FSS with unilateral salpingo-oophorectomy is only advisable for unilateral grade 1 tumors. Further studies employing contemporary classification criteria, such as low- versus highgrade malignancies, a strictly standardized regimen of surgical staging, and meticulous reporting of recurrence localization, may help develop more differentiated recommendations.
Dept. of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Germany. prof.dubois@googlemail.com
Andreas
A
du Bois
Florian
F
Heitz
Philipp
P
Harter
D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology* / Q000517:prevention & control*; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data; D010051:Ovarian Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D010052:Ovariectomy / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D018570:Risk Assessment; D058994:Salpingectomy / Q000706:statistics & numerical data*; D016896:Treatment Outcome