Laparoscopic Fertility-Sparing Surgery for Early Ovarian Malignancies

SIMPLE SUMMARY: The surgical treatment of ovarian cancer traditionally includes bilateral adnexectomy and hysterectomy and thus terminates patients’ fertility. The demand for fertility-sparing surgical treatment options for gynecological cancers has increased in the last decade due to socioeconomic changes such as increased maternal age at first pregnancy, increased occurrence of malignancies in younger patients, and technical progress in surgery that enables such options. Randomized controlled trials examining the fertility-sparing treatment of ovarian cancer are lacking, but retrospective studies, including primarily patients treated with open surgery, have yielded comparable survival data with acceptable fertility outcomes and provide a rationale for the offering of fertility-sparing options to selected patients with early ovarian cancer. The aim of this study was to accumulate additional evidence on oncological safety and fertility outcomes in patients with early-stage ovarian cancer treated with laparoscopic fertility-sparing surgery. ABSTRACT: The demand for fertility-sparing surgery (FSS) has increased in the last decade due to increased maternal age, increased incidence of ovarian malignancies in younger patients, and technical advances in surgery. Data on oncological safety and fertility outcomes of patients with ovarian cancer after laparoscopic FSS are sparse, but some retrospective studies have shown that open FSS may be offered to selected patients. We assessed the role of minimally invasive FSS in comparison with radical surgery (RS) in terms of oncological safety and reproductive outcomes after FSS in this multicenter study. Eighty patients with FIGO stage I/II ovarian cancer treated with laparoscopic FSS or RS between 01/2000 and 10/2018 at the participating centers (comprehensive gynecological cancer centers with minimally invasive surgical expertise) were included in this retrospective analysis of prospectively kept data. Case–control (n = 40 each) matching according to the FIGO stage was performed. Progression-free survival [150 (3–150) and 150 (5–150) months; p = 0.61] and overall survival [36 (3–150) and 50 (1–275) months; p = 0.65] did not differ between the FSS and RS groups. Eight (25.8%) women became pregnant after FSS, resulting in seven (22.5%) deliveries; three (37.5%) patients conceived after in vitro fertilization, and five (62.5%) conceived spontaneously. Laparoscopic FSS seems to be applicable and oncologically safe for patients with early-stage ovarian cancer, with adequate fertility outcomes.