Obstet Gynecol Sci.  2017 May;60(3):289-295. 10.5468/ogs.2017.60.3.289.

Oncologic and obstetric outcomes of conservative surgery for borderline ovarian tumors in women of reproductive age

Affiliations
  • 1Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
  • 2Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea. chanoncology@chamc.co.kr

Abstract


OBJECTIVE
To compare the oncologic and obstetric outcomes in reproductive-age females with borderline ovarian tumors (BOTs) treated with cyst enucleation (CE) or unilateral salpingo-oophorectomy (USO).
METHODS
The medical records of patients with BOTs treated between 1998 and 2014 were retrospectively reviewed. The recurrence rates in the USO and CE groups were compared, and the postoperative obstetric outcomes were assessed via telephone survey.
RESULTS
Eighty-nine patients with BOTs underwent USO, and 19 underwent CE. Of these, six patients had recurrent BOTs. The recurrence rate was significantly lower in the USO group (3/89, 3.4%) than in the CE group (3/19, 15.8%) (P=0.032). All patients with recurrent disease were successfully treated with further surgery. Of the 76 patients interviewed by telephone, 71 (93.4%) resumed regular menstruation after surgery. Twenty-six of the 32 patients (81.3%) who attempted to conceive had successful pregnancies. USO (19/24, 79.2%), like CE (7/8, 87.5%), resulted in favorable pregnancy rates for patients with BOTs.
CONCLUSION
USO is a suitable fertility-preserving surgery for women with BOTs. CE is also an acceptable option for select patients.

Keyword

Borderline ovarian tumor; Fertility preservation; Pregnancy; Recurrence

MeSH Terms

Female
Fertility Preservation
Humans
Medical Records
Menstruation
Pregnancy
Pregnancy Rate
Recurrence
Retrospective Studies
Telephone

Figure

  • Fig. 1 Recurrence-free survival according to the type of fertility-sparing surgery. USO, unilateral salpingo-oophorectomy with or without contralateral ovarian cyst enucleation; CE, unilateral or bilateral cyst enucleation.


Reference

1. Morice P, Uzan C, Fauvet R, Gouy S, Duvillard P, Darai E. Borderline ovarian tumour: pathological diagnostic dilemma and risk factors for invasive or lethal recurrence. Lancet Oncol. 2012; 13:e103–e115.
2. Tinelli R, Tinelli A, Tinelli FG, Cicinelli E, Malvasi A. Conservative surgery for borderline ovarian tumors: a review. Gynecol Oncol. 2006; 100:185–191.
3. Skirnisdottir I, Garmo H, Wilander E, Holmberg L. Borderline ovarian tumors in Sweden 1960-2005: trends in incidence and age at diagnosis compared to ovarian cancer. Int J Cancer. 2008; 123:1897–1901.
4. Ouldamer L, Bendifallah S, Naoura I, Body G, Uzan C, Morice P, et al. Nomogram to predict live birth rate after fertility-sparing surgery for borderline ovarian tumours. Hum Reprod. 2016; 31:1732–1737.
5. Gungor T, Cetinkaya N, Yalcin H, Ozdal B, Ozgu E, Baser E, et al. Retrospective evaluation of borderline ovarian tumors: single center experience of 183 cases. Arch Gynecol Obstet. 2015; 291:123–130.
6. De Iaco P, Ferrero A, Rosati F, Melpignano M, Biglia N, Rolla M, et al. Behaviour of ovarian tumors of low malignant potential treated with conservative surgery. Eur J Surg Oncol. 2009; 35:643–648.
7. Levine J, Canada A, Stern CJ. Fertility preservation in adolescents and young adults with cancer. J Clin Oncol. 2010; 28:4831–4841.
8. Uzan C, Nikpayam M, Ribassin-Majed L, Gouy S, Bendifallah S, Cortez A, et al. Influence of histological subtypes on the risk of an invasive recurrence in a large series of stage I borderline ovarian tumor including 191 conservative treatments. Ann Oncol. 2014; 25:1312–1319.
9. Kwon YS, Hahn HS, Kim TJ, Lee IH, Lim KT, Lee KH, et al. Fertility preservation in patients with early epithelial ovarian cancer. J Gynecol Oncol. 2009; 20:44–47.
10. Donnez J, Martinez-Madrid B, Jadoul P, Van Langendonckt A, Demylle D, Dolmans MM. Ovarian tissue cryopreservation and transplantation: a review. Hum Reprod Update. 2006; 12:519–535.
11. Donnez J, Munschke A, Berliere M, Pirard C, Jadoul P, Smets M, et al. Safety of conservative management and fertility outcome in women with borderline tumors of the ovary. Fertil Steril. 2003; 79:1216–1221.
12. Morice P, Camatte S, Wicart-Poque F, Atallah D, Rouzier R, Pautier P, et al. Results of conservative management of epithelial malignant and borderline ovarian tumours. Hum Reprod Update. 2003; 9:185–192.
13. Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH. Surgical management of borderline ovarian tumors: the role of fertility-sparing surgery. Gynecol Oncol. 2009; 113:75–82.
14. Fauvet R, Poncelet C, Boccara J, Descamps P, Fondrinier E, Darai E. Fertility after conservative treatment for borderline ovarian tumors: a French multicenter study. Fertil Steril. 2005; 83:284–290.
15. Yinon Y, Beiner ME, Gotlieb WH, Korach Y, Perri T, Ben-Baruch G. Clinical outcome of cystectomy compared with unilateral salpingo-oophorectomy as fertility-sparing treatment of borderline ovarian tumors. Fertil Steril. 2007; 88:479–484.
16. Song T, Hun Choi C, Lee YY, Kim TJ, Lee JW, Bae DS, et al. Oncologic and reproductive outcomes of cystectomy compared with oophorectomy as a treatment for borderline ovarian tumours. Hum Reprod. 2011; 26:2008–2014.
17. Song T, Lee YY, Choi CH, Kim TJ, Lee JW, Bae DS, et al. Histologic distribution of borderline ovarian tumors worldwide: a systematic review. J Gynecol Oncol. 2013; 24:44–51.
18. Koskas M, Uzan C, Gouy S, Pautier P, Lhomme C, Haie-Meder C, et al. Fertility determinants after conservative surgery for mucinous borderline tumours of the ovary (excluding peritoneal pseudomyxoma). Hum Reprod. 2011; 26:808–814.
19. Koskas M, Uzan C, Gouy S, Pautier P, Lhomme C, Haie-Meder C, et al. Prognostic factors of a large retrospective series of mucinous borderline tumors of the ovary (excluding peritoneal pseudomyxoma). Ann Surg Oncol. 2011; 18:40–48.
20. Park JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT, et al. Outcomes of fertility-sparing surgery for invasive epithelial ovarian cancer: oncologic safety and reproductive outcomes. Gynecol Oncol. 2008; 110:345–353.
21. Schilder JM, Thompson AM, DePriest PD, Ueland FR, Cibull ML, Kryscio RJ, et al. Outcome of reproductive age women with stage IA or IC invasive epithelial ovarian cancer treated with fertility-sparing therapy. Gynecol Oncol. 2002; 87:1–7.
22. Song T, Choi CH, Kim HJ, Lee W, Lee YY, Kim TJ, et al. Oncologic and reproductive outcomes in patients with advanced-stage borderline ovarian tumors. Eur J Obstet Gynecol Reprod Biol. 2011; 156:204–208.
23. Uzan C, Kane A, Rey A, Gouy S, Duvillard P, Morice P. Outcomes after conservative treatment of advanced-stage serous borderline tumors of the ovary. Ann Oncol. 2010; 21:55–60.
24. Vasconcelos I, de Sousa Mendes M. Conservative surgery in ovarian borderline tumours: a meta-analysis with emphasis on recurrence risk. Eur J Cancer. 2015; 51:620–631.
25. Barakat RR, Benjamin I, Lewis JL Jr, Saigo PE, Curtin JP, Hoskins WJ. Platinum-based chemotherapy for advanced-stage serous ovarian carcinoma of low malignant potential. Gynecol Oncol. 1995; 59:390–393.
26. Fischerova D, Zikan M, Dundr P, Cibula D. Diagnosis, treatment, and follow-up of borderline ovarian tumors. Oncologist. 2012; 17:1515–1533.
27. Shih KK, Zhou QC, Aghajanian C, Huh J, Soslow RA, Morgan JC, et al. Patterns of recurrence and role of adjuvant chemotherapy in stage II-IV serous ovarian borderline tumors. Gynecol Oncol. 2010; 119:270–273.
28. Gershenson DM, Silva EG, Levy L, Burke TW, Wolf JK, Tornos C. Ovarian serous borderline tumors with invasive peritoneal implants. Cancer. 1998; 82:1096–1103.
29. Uzan C, Muller E, Kane A, Rey A, Gouy S, Bendiffallah S, et al. Prognostic factors for recurrence after conservative treatment in a series of 119 patients with stage I serous borderline tumors of the ovary. Ann Oncol. 2014; 25:166–171.
30. Vasconcelos I, Olschewski J, Braicu I, Sehouli J. Limited efficacy of platinum-based adjuvant treatment on the outcome of borderline ovarian tumors. Eur J Obstet Gynecol Reprod Biol. 2015; 186:26–33.
Full Text Links
  • OGS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr