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Background@#Early stage ovarian cancer may be managed with fertility-sparing surgery, to preserve the uterus and contralateral ovary, thus preserving future reproductive function. The aim of this study was to determine the reproductive outcome of early stage ovarian cancer managed conservatively by unilateral salpingooophorectomy, and to compare the survival and recurrence rate among those who had and did not have pregnancy after treatment. @*Methodology:@#A retrospective cohort study was conducted on 34 patients with early stage ovarian cancer who underwent fertility-sparing surgery from January 2005 to December 2018. Fertility outcome following treatment was determined. Survival and recurrence rate was analyzed between those who had and did not have pregnancy after surgery.@*Results@#A total of 34 out of 661 (5.14%) new cases of ovarian cancer who underwent fertility-sparing surgery were analyzed, with a mean age of 23.71 ± 5.57 years (range: 12-36 years old), with the most common complaints of increasing abdominal girth (11/34, 32.35%) or palpable abdominal mass (11/34, 32.35%). Successful pregnancy was seen in 9 cases (26.47%), with 2 of them currently pregnant. Overall recurrence and survival rates were 14.71% and 91.18%, respectively. There was no statistically significant difference in the survival rate (88.89% vs 92%, p-value 0.7778) and rate of recurrence (22.22% and 12%, p-value 0.4578) between those who got pregnant after fertility-sparing surgery for early stage ovarian cancer, FIGO Stage IA and IC, compared to those who did not get pregnant.@*Conclusions@#Fertility-sparing surgery can be effectively offered to young patients with early stage ovarian cancer, to preserve reproductive function, with 26.47% successful pregnancy rate. Pregnancy had no significant effect on recurrence and survival among FIGO stage IA and IC ovarian cancer who underwent fertility-sparing surgery by unilateral salpingooophorectomy.
Subject(s)
Fertility , Health Services , Ovarian NeoplasmsABSTRACT
OBJECTIVE: To investigate the surgical and oncological outcomes of laparoscopic surgery compared with laparotomy for the treatment of early-stage ovarian cancer. METHODS: Data from patients who underwent surgical management for early-stage ovarian cancer between 2006 and 2012 were retrospectively reviewed. All patients presented with stage I or II disease, and underwent comprehensive staging surgery consisting of a total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, omentectomy, and peritoneal cytology. RESULTS: Seventy-seven patients who underwent laparoscopic surgery (24 patients) or laparotomy (53 patients) were identified. Surgery for none of the patients was converted from laparoscopy to laparotomy. The mean operation time was shorter and the estimated blood loss was lower in the laparoscopy group than in the laparotomy group, though the differences were not statistically significant (193 min vs. 224 min, p=0.127; 698 mL vs. 973 mL, p=0.127). There were no differences in the intraoperative or postoperative complications. During a mean follow-up period of 31 months, tumor recurrence occurred in 4 patients: 2 (8.3%) in the laparoscopy group and 2 (3.8%) in the laparotomy group. The mean disease-free survival was 59 months after laparoscopy and 66 months after laparotomy (p=0.367). CONCLUSION: Laparoscopic surgery seems to be adequate and feasible for the treatment of early-stage ovarian cancer with comparable results to laparotomy in terms of the surgical outcomes and oncological safety.
Subject(s)
Humans , Disease-Free Survival , Follow-Up Studies , Hysterectomy , Laparoscopy , Laparotomy , Lymph Node Excision , Ovarian Neoplasms , Postoperative Complications , Recurrence , Retrospective StudiesABSTRACT
Objective:This study aimed to assess the efficacy of comprehensive laparoscopic surgical staging in early-stage ovari-an cancer, and provide references for clinical practice and research. Methods: Electronic databases, such as Embase, Medline, Co-chrane Library, CBM, and CNKI, were searched for studies on comprehensive laparoscopic surgical staging versus comprehensive lapa-rotomic surgical staging. Other sources, such as related references, were also retrieved. The literature was screened according to inclu-sion criteria. Data were extracted from the selected references, and the quality of the included studies was assessed. This meta-analysis was performed using RevMan 5.2 software. Results:A total of 11 studies involving 591 cases were selected, of which 235 cases be-longed to the laparoscopy group and 356 belonged to the laparotomy group. No statistically significant differences were observed be-tween groups in age, body mass index, clinical stage, histological type, and histological grade. The laparoscopy group had less intraoper-ative blood loss, earlier general diet intake, less postoperative complications, and lower postoperative recurrence rate than the laparoto-my group. No statistically significant difference was observed between groups in operation time, pelvic lymph node number (apart from pelvic and para-aortic lymph nodes), mortality. Conclusion:The results of this systematic review show that laparoscopic surgical stag-ing of early-stage ovarian cancer demonstrated staging adequacy and accuracy that were similar to those of laparotomic surgical stag-ing. Based on the principle of minimal invasion and radical treatment to tumor, laparoscopy showed more favorable operative outcomes than laparotomy.
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OBJECTIVE: The aim of this study was to evaluate the impact of para-aortic lymphadenectomy up to the renal vessels on the accurate staging in ovarian cancer patients presumed preoperatively to be confined to the ovary. METHODS: We retrospectively analyzed data on 124 patients with primary epithelial ovarian cancer who were preoperatively thought to have tumor confined to the ovary and underwent primary staging surgery. The distribution of lymph node metastasis and various risk factors for nodal involvement were investigated. RESULTS: Surgical staging yielded: 87 (70.2%) patients had International Federation of Gynecology and Obstetrics (FIGO) stage I disease and 37 (29.8%) patients had stage II-III disease: 4 IIA, 6 IIB, 9 IIC, 1 IIIA, and 17 IIIC. Eighty-six patients had pelvic lymphadenectomy only and 69 had pelvic and para-aortic lymphadenectomy. Lymph node metastases were found in 17 (24.6%) of 69 patients; 5 (7.2%) patients had lymph node metastasis in the pelvic lymph nodes only, 8 (11.6%) in the para-aortic lymph nodes only, and 4 (5.8%) in both pelvic and para-aortic lymph nodes. Six (8.7%) patients had lymph node metastasis in the para-aortic lymph node above the level of the inferior mesenteric artery. On multivariate analysis, grade 3 tumor (p=0.01) and positive cytology (p=0.03) were independent predictors for lymph node metastasis. CONCLUSION: A substantial number of patients with apparently early ovarian cancer had upstaged disease. Of patients who underwent lymphadenectomy, some patients had lymph node metastasis above the level of the inferior mesenteric artery. Para-aortic lymphadenectomy up to the renal vessels may detect occult metastasis and be of help in tailoring appropriate adjuvant treatment as well as giving useful information about the prognosis.