Long-Term Survival After Fertility-Sparing Surgery for Epithelial Ovarian Cancer

Objective: To determine the long-term results of fertility-sparing surgery in the treatment of early-stage invasive epithelial ovarian cancer. Methods: A retrospective review of 123 patients who underwent surgical staging for FIGO stage I epithelial ovarian cancer from November 1982 to July 2002. Demographics, stage, histopathology, adjuvant therapy, recurrence, and survival were compared for patients who had fertility-sparing surgery and for those having standard surgical staging. Results: Twenty patients, with a median age of 27 years, had preservation of the uterus and contralateral ovary at the time of surgical staging. Platinum-based chemotherapy was administered to 50% of these patients postoperatively. Three patients (15%) recurred in the retained ovary at 9, 20, and 22 months, and all died of their disease. One patient was diagnosed with primary endometrial cancer at 15 months and was salvaged with hysterectomy. At a median follow-up of 122 months, 17 (85%) of 20 patients treated with fertility-sparing surgery were alive without disease. Of the 10, 3 patients treated with removal of the uterus and both ovaries, 72% received adjuvant platinum chemotherapy. Twenty (19%) of the patients in the standard surgery group have recurred, and 17 have died of disease. At a median follow-up of 113 months, 78 (76%) of 103 patients treated with standard surgery were alive without disease. Five-year survival data showed no significant difference in the recurrence-free survival of the fertility-sparing and standard surgery groups (84% vs 78%) or overall survival (84% vs 82%). Conclusion: Fertility-sparing surgery is a reasonable alternative treatment for young women with stage I epithelial ovarian cancer desiring fertility preservation.