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Fertility Sparing Surgery and Borderline Ovarian Tumours

SIMPLE SUMMARY: Fertility-sparing surgery (FSS) is now a widely acceptable treatment for the management of Borderline Ovarian Tumours (BOTs) in women of reproductive age. However, many clinicians face the dilemma of balancing the risks of disease recurrence with progression to lethal malignancy whil...

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Autores principales: Kasaven, Lorraine S., Chawla, Mehar, Jones, Benjamin P., Al-Memar, Maya, Galazis, Nicolas, Ahmed-Salim, Yousra, El-Bahrawy, Mona, Lavery, Stuart, Saso, Srdjan, Yazbek, Joseph
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8946233/
https://www.ncbi.nlm.nih.gov/pubmed/35326636
http://dx.doi.org/10.3390/cancers14061485
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author Kasaven, Lorraine S.
Chawla, Mehar
Jones, Benjamin P.
Al-Memar, Maya
Galazis, Nicolas
Ahmed-Salim, Yousra
El-Bahrawy, Mona
Lavery, Stuart
Saso, Srdjan
Yazbek, Joseph
author_facet Kasaven, Lorraine S.
Chawla, Mehar
Jones, Benjamin P.
Al-Memar, Maya
Galazis, Nicolas
Ahmed-Salim, Yousra
El-Bahrawy, Mona
Lavery, Stuart
Saso, Srdjan
Yazbek, Joseph
author_sort Kasaven, Lorraine S.
collection PubMed
description SIMPLE SUMMARY: Fertility-sparing surgery (FSS) is now a widely acceptable treatment for the management of Borderline Ovarian Tumours (BOTs) in women of reproductive age. However, many clinicians face the dilemma of balancing the risks of disease recurrence with progression to lethal malignancy whilst preserving fertility, in the absence of clear standardized guidelines. The aim of this study was to evaluate the oncological outcomes in women who underwent FSS for the management of primary, or recurrent presentation of BOTs, to provide clinicians with further evidence of the safety and feasibility of FSS. Oncological outcomes following a novel method of FSS in the form of laparoscopic ultrasound guided ovarian wedge resection has also been introduced, which has the potential to change the way BOTs are managed in the future in women of reproductive age. ABSTRACT: To determine the oncological outcomes following fertility-sparing surgery (FSS) for the management of Borderline Ovarian Tumours (BOTs). A retrospective analysis of participants diagnosed with BOTs between January 2004 and December 2020 at the West London Gynaecological Oncology Centre was conducted. A total of 172 women were diagnosed; 52.3% (90/172) underwent FSS and 47.7% (82/172) non-FSS. The overall recurrence rate of disease was 16.9% (29/172), of which 79.3% (23/29) presented as the recurrence of serous or sero-mucinous BOTs and 20.7% (6/29) as low-grade serous carcinoma (LGSC). In the FSS group, the recurrence rate of BOTs was 25.6% (23/90) presenting a median 44.0 (interquartile range (IQR) 41.5) months, of which there were no episodes of recurrence presenting as LGSC reported. In the non-FSS group, all recurrences of disease presented as LGSC, with a rate of 7.7% (6/78), following a median of 47.5 months (IQR 47.8). A significant difference between the type of surgery performed (FSS v Non-FSS) and the association with recurrence of BOT was observed (Pearson Chi-Square: p = 0.000; x = 20.613). Twelve women underwent ultrasound-guided ovarian wedge resection (UGOWR) as a novel method of FSS. Recurrence of BOT was not significantly associated with the type of FSS performed (Pearson Chi- Square: x = 3.166, p = 0.379). Non-FSS is associated with negative oncological outcomes compared to FSS, as evidenced by the higher rate of recurrence of LGSC. This may be attributed to the indefinite long-term follow up with ultrasound surveillance all FSS women undergo, enabling earlier detection and treatment of recurrences.
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spelling pubmed-89462332022-03-25 Fertility Sparing Surgery and Borderline Ovarian Tumours Kasaven, Lorraine S. Chawla, Mehar Jones, Benjamin P. Al-Memar, Maya Galazis, Nicolas Ahmed-Salim, Yousra El-Bahrawy, Mona Lavery, Stuart Saso, Srdjan Yazbek, Joseph Cancers (Basel) Article SIMPLE SUMMARY: Fertility-sparing surgery (FSS) is now a widely acceptable treatment for the management of Borderline Ovarian Tumours (BOTs) in women of reproductive age. However, many clinicians face the dilemma of balancing the risks of disease recurrence with progression to lethal malignancy whilst preserving fertility, in the absence of clear standardized guidelines. The aim of this study was to evaluate the oncological outcomes in women who underwent FSS for the management of primary, or recurrent presentation of BOTs, to provide clinicians with further evidence of the safety and feasibility of FSS. Oncological outcomes following a novel method of FSS in the form of laparoscopic ultrasound guided ovarian wedge resection has also been introduced, which has the potential to change the way BOTs are managed in the future in women of reproductive age. ABSTRACT: To determine the oncological outcomes following fertility-sparing surgery (FSS) for the management of Borderline Ovarian Tumours (BOTs). A retrospective analysis of participants diagnosed with BOTs between January 2004 and December 2020 at the West London Gynaecological Oncology Centre was conducted. A total of 172 women were diagnosed; 52.3% (90/172) underwent FSS and 47.7% (82/172) non-FSS. The overall recurrence rate of disease was 16.9% (29/172), of which 79.3% (23/29) presented as the recurrence of serous or sero-mucinous BOTs and 20.7% (6/29) as low-grade serous carcinoma (LGSC). In the FSS group, the recurrence rate of BOTs was 25.6% (23/90) presenting a median 44.0 (interquartile range (IQR) 41.5) months, of which there were no episodes of recurrence presenting as LGSC reported. In the non-FSS group, all recurrences of disease presented as LGSC, with a rate of 7.7% (6/78), following a median of 47.5 months (IQR 47.8). A significant difference between the type of surgery performed (FSS v Non-FSS) and the association with recurrence of BOT was observed (Pearson Chi-Square: p = 0.000; x = 20.613). Twelve women underwent ultrasound-guided ovarian wedge resection (UGOWR) as a novel method of FSS. Recurrence of BOT was not significantly associated with the type of FSS performed (Pearson Chi- Square: x = 3.166, p = 0.379). Non-FSS is associated with negative oncological outcomes compared to FSS, as evidenced by the higher rate of recurrence of LGSC. This may be attributed to the indefinite long-term follow up with ultrasound surveillance all FSS women undergo, enabling earlier detection and treatment of recurrences. MDPI 2022-03-14 /pmc/articles/PMC8946233/ /pubmed/35326636 http://dx.doi.org/10.3390/cancers14061485 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kasaven, Lorraine S.
Chawla, Mehar
Jones, Benjamin P.
Al-Memar, Maya
Galazis, Nicolas
Ahmed-Salim, Yousra
El-Bahrawy, Mona
Lavery, Stuart
Saso, Srdjan
Yazbek, Joseph
Fertility Sparing Surgery and Borderline Ovarian Tumours
title Fertility Sparing Surgery and Borderline Ovarian Tumours
title_full Fertility Sparing Surgery and Borderline Ovarian Tumours
title_fullStr Fertility Sparing Surgery and Borderline Ovarian Tumours
title_full_unstemmed Fertility Sparing Surgery and Borderline Ovarian Tumours
title_short Fertility Sparing Surgery and Borderline Ovarian Tumours
title_sort fertility sparing surgery and borderline ovarian tumours
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8946233/
https://www.ncbi.nlm.nih.gov/pubmed/35326636
http://dx.doi.org/10.3390/cancers14061485
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