title: Should ovaries be removed or not in (early-stage) adenocarcinoma of the uterine cervix: a review.
abstract: OBJECTIVE
  There is considerable controversy regarding the safety of ovarian preservation in adenocarcinoma of the cervix. The aim of this review is to determine the incidence of ovarian metastasis in patients with adenocarcinoma of the cervix (particularly in early-stage disease), identify risk factors for ovarian metastasis and evaluate the outcome of patients with ovarian preservation.
  
  
  METHODS
  Relevant articles were identified from MEDLINE and EMBASE. Included studies were prospective or retrospective cohort and cross-sectional studies analyzing the incidence of ovarian metastasis in adenocarcinoma of the cervix and studies evaluating the outcome of patients with ovarian preservation.
  
  
  RESULTS
  Ten articles including 1204 patients evaluated the frequency of ovarian metastasis. The incidence considering all FIGO stages was 3.7% (range: 0%-12.9%) and the incidence in FIGO stage IB was 2% (range: 0.8%-3.2%). Six articles evaluated the outcome of patients with ovarian preservation. With more than 100 patients with adenocarcinoma of the cervix FIGO stage (CIS-IIA), none developed an ovarian relapse with a mean follow-up time of 56months. Six articles including 31 patients with ovarian spread were analyzed. At least one of the following risk factor was present in 30/31 (96.7%) of the patients: age >45, FIGO stage >IB, positive lymph nodes, deep stromal invasion, lympho-vascular space invasion, corpus invasion, parametrial invasion or tumor size >4cm.
  
  
  CONCLUSIONS
  Ovarian preservation in young women with early-stage adenocarcinoma of the uterine cervix is safe. Herein, we propose a set of selection criteria to properly identify candidates for ovarian preservation.
authors.forename: Omar
authors.initials: O
authors.lastname: Touhami
authors.affiliation: Gynecologic Oncology Division, Centre Hospitalier Universitaire de Québec, L'Hôtel-Dieu de Québec, Laval University, Quebec City, Quebec, Canada.
authors.forename: Touhami
authors.initials: T
authors.lastname: Omar
authors.forename: Marie
authors.initials: M
authors.lastname: Plante
authors.affiliation: Gynecologic Oncology Division, Centre Hospitalier Universitaire de Québec, L'Hôtel-Dieu de Québec, Laval University, Quebec City, Quebec, Canada. Electronic address: Marie.plante@crhdq.ulaval.ca.
authors.forename: Plante
authors.initials: P
authors.lastname: Marie
mesh_terms: D005260:Female; D006801:Humans; D009362:Neoplasm Metastasis; D010051:Ovarian Neoplasms / Q000517:prevention & control* / Q000556:secondary; D010053:Ovary / Q000601:surgery*; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Adenocarcinoma; Cervical cancer; Ovarian metastasis; Ovarian preservation; Risk factors