Malignant Ovarian Germ Cell Tumors: Ovarian Function after Conservative Surgery and the Importance of Lymph Node Evaluation

Kim, Dae Yeon; Nam, Joo Hyun; Yoo, Hang Jo; Kim, Mi Kyung; Kim, Jong Hyeok; Kim, Yong Man; Kim, Young Tak; Mok, Jung Eun

Abstract

OBJECTIVE
To evaluate the long-term fertility and reproductive outcomes after conservative surgery, to observe the recurrence pattern and to elucidate the significance of retroperitoneal lymph node evaluation in patients with malignant ovarian germ cell tumors.
METHODS
We reviewed the medical records of fifty patients who had been diagnosed as malignant ovarian germ cell tumors from 1991 to 2001 at Asan Medical Center.
RESULTS
During on the median follow-up of 54 months, six patients recurred and five patients died. Out of the six recurred patients, three patients (50%) were found to have retroperitoneal lymph nodes involved, especially in patients with dysgerminoma and one patient contralateral ovary involved after conservative surgery. Out of the forty patients who had received conservative surgery, twenty-two (55.0%) had stage Ia tumors and thirteen (32.5%) had stage II and III. Adjuvant chemotherapy was performed for thirty- one patients (77.5%) and comprehensive surgical staging including retroperitoneal lymph node evaluation was performed for six patients (15%). During chemotherapy, fifteen patients out of nineteen with normal menstrual cycles became amenorrheic but most of them (13/15) recovered their normal menstrual cycles and gave birth to five healthy babies. Out of the thirteen patients with advanced disease who had received conservative surgery, two patients died after recurrences and one died of disease progression.
CONCLUSION
Conservative surgery is the treatment of choice in young women with early stage disease, but in case of advanced disease, it requires prudent decision-making. Considering conservative surgery, retroperitoneal lymph node evaluation is needed, especially in patients with dysgerminoma.