Cargando…
Fertility-sparing surgery for young patients with borderline ovarian tumors (BOTs): single institution experience
BACKGROUND: Fertility-sparing surgery for patients with borderline ovarian tumors (BOTs) is still controversial. This study aimed to evaluate the oncological safety and fertility benefits in conservative surgery,as well as efficiency of surgical procedures and approaches. RESULTS: In total 122 patie...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4797121/ https://www.ncbi.nlm.nih.gov/pubmed/26988551 http://dx.doi.org/10.1186/s13048-016-0226-y |
_version_ | 1782421891294691328 |
---|---|
author | Chen, Rui-fang Li, Jun Zhu, Ting-ting Yu, Hai-lin Lu, Xin |
author_facet | Chen, Rui-fang Li, Jun Zhu, Ting-ting Yu, Hai-lin Lu, Xin |
author_sort | Chen, Rui-fang |
collection | PubMed |
description | BACKGROUND: Fertility-sparing surgery for patients with borderline ovarian tumors (BOTs) is still controversial. This study aimed to evaluate the oncological safety and fertility benefits in conservative surgery,as well as efficiency of surgical procedures and approaches. RESULTS: In total 122 patients with BOTs, four types of fertility-sparing surgery were performed: unilateral adnexectomy (UA, n = 47), unilateral cystectomy (UC, n = 59), unilateral adnexectomy + contralateral cystectomy (UA + CC, n = 7) and bilateral cystectomy (BC, n = 9). Fifty-two (42.6 %) patients had undergone laparoscopy, while 70 (57.4 %) had undergone laparotomy. After a median follow-up of 58.0 months, eight patients (6.6 %) relapsed in average of 25.9 months. Only one patient progressed to invasive cancer. None died within our observational period. Univariate analysis showed that patients with elevated CA125, bilateral tumors, extra-ovary tumor or mucinous type tended to replase in shorter time (p < 0.05). Among all cases, 45 patients attempted to conceive and 34 (75.6 %) patients had successful pregnancy. The recurrence rates were successively increased (2.1 %, 6.8 %, 14.3 %, and 22.2 %), the recurrence interval were shortened (48.0, 25.3, 26.0 and 21.2 months) and the subsequent fertility rates were 76.9 %, 77.3 %, 66.7 % and 71.4 % in UA, UC, UA + CC, and BC groups, respectively. As for surgical approaches, three patients (5.8 %) relapsed in 26.3 months in the laparoscopy group and five (7.1 %) in 25.5 months in the laparotomy group. The subsequent fertility rate was higher in laparoscopy group (88.9 %) than in laparotomy group (66.7 %). In our study, 38 patients underwent staging surgery. Two patients (5.3 %) recurrent in average of 21.0 months, and the subsequent pregnancy rate of staging surgery group was 61.5 %. Twelve patients received adjuvant chemotherapy but they didn’t get any benefit from it, both in term of recurrence (8.3 %, 26.0 months) and subsequent pregnancy rate (75.5 %). CONCLUSION: Fertility-sparing surgery is safe and beneficial for most young BOTs. UA through laparoscopy should be recommended as the first choice. To the patients with bilateral tumors, elevated CA125, extra-ovary tumor or mucinous type, conservative surgery should be carefully chosen and subsequent pregnancy should be attempted in short term. In addition, the benefit of comprehensive surgical staging is to be further investigated and adjuvant chemotherapy is not recommended. |
format | Online Article Text |
id | pubmed-4797121 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-47971212016-03-18 Fertility-sparing surgery for young patients with borderline ovarian tumors (BOTs): single institution experience Chen, Rui-fang Li, Jun Zhu, Ting-ting Yu, Hai-lin Lu, Xin J Ovarian Res Research BACKGROUND: Fertility-sparing surgery for patients with borderline ovarian tumors (BOTs) is still controversial. This study aimed to evaluate the oncological safety and fertility benefits in conservative surgery,as well as efficiency of surgical procedures and approaches. RESULTS: In total 122 patients with BOTs, four types of fertility-sparing surgery were performed: unilateral adnexectomy (UA, n = 47), unilateral cystectomy (UC, n = 59), unilateral adnexectomy + contralateral cystectomy (UA + CC, n = 7) and bilateral cystectomy (BC, n = 9). Fifty-two (42.6 %) patients had undergone laparoscopy, while 70 (57.4 %) had undergone laparotomy. After a median follow-up of 58.0 months, eight patients (6.6 %) relapsed in average of 25.9 months. Only one patient progressed to invasive cancer. None died within our observational period. Univariate analysis showed that patients with elevated CA125, bilateral tumors, extra-ovary tumor or mucinous type tended to replase in shorter time (p < 0.05). Among all cases, 45 patients attempted to conceive and 34 (75.6 %) patients had successful pregnancy. The recurrence rates were successively increased (2.1 %, 6.8 %, 14.3 %, and 22.2 %), the recurrence interval were shortened (48.0, 25.3, 26.0 and 21.2 months) and the subsequent fertility rates were 76.9 %, 77.3 %, 66.7 % and 71.4 % in UA, UC, UA + CC, and BC groups, respectively. As for surgical approaches, three patients (5.8 %) relapsed in 26.3 months in the laparoscopy group and five (7.1 %) in 25.5 months in the laparotomy group. The subsequent fertility rate was higher in laparoscopy group (88.9 %) than in laparotomy group (66.7 %). In our study, 38 patients underwent staging surgery. Two patients (5.3 %) recurrent in average of 21.0 months, and the subsequent pregnancy rate of staging surgery group was 61.5 %. Twelve patients received adjuvant chemotherapy but they didn’t get any benefit from it, both in term of recurrence (8.3 %, 26.0 months) and subsequent pregnancy rate (75.5 %). CONCLUSION: Fertility-sparing surgery is safe and beneficial for most young BOTs. UA through laparoscopy should be recommended as the first choice. To the patients with bilateral tumors, elevated CA125, extra-ovary tumor or mucinous type, conservative surgery should be carefully chosen and subsequent pregnancy should be attempted in short term. In addition, the benefit of comprehensive surgical staging is to be further investigated and adjuvant chemotherapy is not recommended. BioMed Central 2016-03-18 /pmc/articles/PMC4797121/ /pubmed/26988551 http://dx.doi.org/10.1186/s13048-016-0226-y Text en © Chen et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Chen, Rui-fang Li, Jun Zhu, Ting-ting Yu, Hai-lin Lu, Xin Fertility-sparing surgery for young patients with borderline ovarian tumors (BOTs): single institution experience |
title | Fertility-sparing surgery for young patients with borderline ovarian tumors (BOTs): single institution experience |
title_full | Fertility-sparing surgery for young patients with borderline ovarian tumors (BOTs): single institution experience |
title_fullStr | Fertility-sparing surgery for young patients with borderline ovarian tumors (BOTs): single institution experience |
title_full_unstemmed | Fertility-sparing surgery for young patients with borderline ovarian tumors (BOTs): single institution experience |
title_short | Fertility-sparing surgery for young patients with borderline ovarian tumors (BOTs): single institution experience |
title_sort | fertility-sparing surgery for young patients with borderline ovarian tumors (bots): single institution experience |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4797121/ https://www.ncbi.nlm.nih.gov/pubmed/26988551 http://dx.doi.org/10.1186/s13048-016-0226-y |
work_keys_str_mv | AT chenruifang fertilitysparingsurgeryforyoungpatientswithborderlineovariantumorsbotssingleinstitutionexperience AT lijun fertilitysparingsurgeryforyoungpatientswithborderlineovariantumorsbotssingleinstitutionexperience AT zhutingting fertilitysparingsurgeryforyoungpatientswithborderlineovariantumorsbotssingleinstitutionexperience AT yuhailin fertilitysparingsurgeryforyoungpatientswithborderlineovariantumorsbotssingleinstitutionexperience AT luxin fertilitysparingsurgeryforyoungpatientswithborderlineovariantumorsbotssingleinstitutionexperience |