J Gynecol Oncol.  2020 Nov;31(6):e85. 10.3802/jgo.2020.31.e85.

Feasibility and safety of fertilitysparing surgery in epithelial ovarian cancer with dense adhesion: a longterm result from a single institution

Affiliations
  • 1Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 2Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

Abstract


Objective
We investigated the feasibility and safety of fertility-sparing surgery (FSS) in patients with epithelial ovarian cancer (EOC) with dense adhesions.
Methods
Patients were divided into cases with and without dense adhesions in this retrospective study.
Results
Of the 95 eligible patients, 29 patients had dense adhesions. Mean age, proportion of staging procedure, distribution of histologic type, and co-presence of endometriosis were different (p=0.003, 0.033, 0.011, and 0.011, respectively). The median follow-up period was 57.8 (0.4–230.0) months. There were no differences in the rates of recurrence (21.2% vs. 20.7%, p=1.000) or death (16.7% vs. 6.9%, p=0.332) between the 2 groups. There was no difference in the pattern of recurrence or in disease-free survival (DFS) and overall survival (OS) between the 2 groups. In multivariate analysis, pretreatment cancer antigen-125 >35 U/mL and International Federation of Gynecology and Obstetrics stage IC were significant factors of worse DFS and OS, while dense adhesion was not a prognostic factor for both DFS (hazard ratio [HR]=0.9; 95% confidence interval [CI]=0.3–2.7; p=0.792) and OS (HR=0.2; 95% CI=0.1–1.8; p=0.142), nor were age, proportion of staging procedure, histologic type, and co-presence of endometriosis. Moreover, the distribution of those 2 significant prognostic factors was not different between the 2 groups. Dense adhesions were subgrouped into nontumor and tumor associated dense adhesions for further analysis and the results were same.
Conclusion
FSS is feasible and safe in EOC, regardless of the presence of dense adhesions.

Keyword

Tissue Adhesions; Ovarian Neoplasms; Fertility Preservation; Gynecologic Surgery
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