title: Long-term safety of fertility sparing surgery in early stage ovarian cancer: comparison to standard radical surgical procedures.
abstract: OBJECTIVE
  Fertility-sparing surgery (FSS) is a strategy often considered in young patients with low-grade (G1-2) early-stage epithelial ovarian cancer (eEOC), while is still controversial in high-risk patients. We investigated the role of FSS in low and high-risk eEOC patients undergoing comprehensive surgical staging.
  
  
  METHODS
  We analyzed data from patients operated for an eEOC from 1975 to 2011, focusing on patients submitted to FSS. Seventy patients out of 307 with eEOC were identified. Patients underwent FSS were compared with 237 patients underwent radical-comprehensive-staging (RCS) in the same period. Disease free (DFS) and overall (OS) survivals were evaluated using Kaplan-Meier and Cox models.
  
  
  RESULTS
  Overall, 307 patients had surgery for eEOC: 70 (22.8%) and 237 (77.2%) women had FSS and RCS, respectively. At univariate analysis, the execution of FSS not influenced DFS (HR:1.06 (95%CI: 0.56,2.02); p=0.84) and OS (HR:1.94 (95%CI: 0.75,4.98); p=0.16). Stage of disease was the only factor correlating with DFS (HR:4.73; 95%CI: 2.01,11.11; p<0.001). Independently, increased age (HR per 1-unit of age:1.06 (95%CI: 1.03,1.11); p<0.001) and high risk disease (HR:3.26; 95%CI: 1.23,8.62; p=0.01) remained associated with worse OS. Focusing on the high risk group (stage IAG3 or more) we observed that type of surgery (FSS v. RCS) did not influence DFS (p=0.77, log-rank test) and OS (p=0.08, log-rank test).
  
  
  CONCLUSIONS
  FSS upholds oncologic effectiveness of RCS, preserving reproductive and endocrine functions. FSS does not increase risk of recurrence among high risk eEOC patients. Further prospective studies on this issue are warranted to improve patients' care.
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy. Electronic address: antonino.ditto@istitutotumori.mi.it.
authors.forename: Antonino
authors.initials: A
authors.lastname: Ditto
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Martinelli
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Lorusso
authors.affiliation: Department of Pathology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Carcangiu
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Chiappa
authors.affiliation: Department of Gynecologic and Obstetrics, Crema, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Reato
authors.affiliation: Department of Gynecology, Obstetrics and Urology, Policlinico Umberto I, University 'Sapienza', Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Donfrancesco
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Karla Jeanette Amaya
authors.initials: KJ
authors.lastname: De Carrillo
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Raspagliesi
mesh_terms: D000328:Adult; D000077216:Carcinoma, Ovarian Epithelial; D018572:Disease-Free Survival; D005260:Female; D059247:Fertility Preservation / Q000009:adverse effects* / Q000379:methods*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: Fertility-sparing; Lymphadenectomy; Ovarian cancer; Survival; Upstaging