Pregnancy outcomes after conservative surgical management of ovarian neoplasms treated at a single institution.

HYPOTHESIS: Conservative surgical management of ovarian neoplasms can result in favorable oncologic and obstetric outcomes. METHODS: All reproductive-age women (18-45 years old) with stage IA to stage IIC ovarian neoplasms (N = 161) were retrospectively identified from a single institution's tumor registry between 1990 and 2007. Operative, pathological, outpatient, and delivery records were reviewed to confirm histological findings, stage, extent of surgical resection, adjuvant treatment, oncologic outcomes, and pregnancy outcomes. RESULTS: Women who underwent conservative surgical management for ovarian neoplasms (n = 61 [37.9%]) were identified, including those with low malignant potential (LMP, n = 36), epithelial (n = 12), germ cell (n = 6), and sex cord (n = 7) tumors. Thirteen women conceived 23 pregnancies, producing a pregnancy rate of 25.0% overall and of 68.4% for those attempting conception. Women with LMP tumors conceived most pregnancies and had the highest number of antenatal complications. Of those receiving adjuvant chemotherapy (n = 8), 12.5% were able to conceive after their treatment and with no reported congenital anomalies. Pregnancy after a diagnosis of ovarian neoplasm did not impact disease recurrence (0% vs 7.7%, P = 0.56) or survival (100% vs 100%, P = 1.0). CONCLUSIONS: Conservative surgery may be an acceptable option for reproductive-age women with early-stage ovarian neoplasms. We report pregnancy and oncologic outcomes for a cohort of women managed conservatively for LMP, epithelial, germ cell, and sex cord ovarian neoplasms.

Cervical cancer and risk for delivery of small-for-gestational age neonates.

OBJECTIVE: To determine if cervical intraepithelial neoplasia grade 3 (CIN-3) and cervical cancer are associated with adverse obstetrical outcomes. METHODS: Women with diagnoses of CIN-3 and cervical cancer were first identified from the University of Pittsburgh Medical Center (UPMC) Network Cancer Registry by using respective ICD-3 codes. Identified records were then linked to the Magee Obstetrical Maternal and Infant (MOMI) database to identify women who subsequently delivered pregnancies at Magee-Womens Hospital. Women with cervical disease were compared with women without known disease to determine the impact of cervical disease on various maternal and neonatal outcomes. The latter group consisted of those women who delivered singleton pregnancies at our institution, as determined by the MOMI database, but who did not have any matching records in the UPMC Cancer Registry. Statistical significance was defined by a p value <0.05. RESULTS: We identified CIN-3 (n = 52) and cervical cancer patients (n = 83) who later had documented pregnancies delivered at Magee-Womens Hospital between 1989 and 2006. Women with cervical cancer and CIN-3 were at greater risk to deliver small-for-gestational age (SGA) neonates compared with women without known cervical disease (RR 1.54, 95% confidence interval [CI] 1.0-2.46). A secondary analysis of risk factors for SGA neonates demonstrated a significant association with cervical cancer (p = 0.04). After accounting for variables known to be risk factors for SGA, cervical cancer was associated with a 1.9-fold increased risk of a SGA delivery (OR 1.9, 95% CI 1.1-3.4). CONCLUSIONS: Cervical cancer is a risk factor for delivery of an SGA neonate in a subsequent pregnancy.

Pregnancy after tumor debulking and intraperitoneal cisplatin for appendiceal carcinoid tumor.

BACKGROUND: Pregnancy after cytoreductive surgery and intraperitoneal chemotherapy is rare. CASE: We present the case of a 25-year-old woman with appendiceal carcinoid tumor treated with intraperitoneal cisplatin for peritoneal recurrence after a fertility-sparing cytoreductive procedure. Five years after her procedure, she conceived with the help of assisted reproductive technologies and delivered a viable term fetus via cesarean delivery. She subsequently had a successful second pregnancy and is currently alive without evidence of her disease. CONCLUSION: Conception is possible after tumor debulking and intraperitoneal chemotherapy. In unique clinical situations, fertility-sparing surgery may be considered in young patients who desire future pregnancy.