Gry Johansen1, Pernilla Dahm-Kähler2, Christian Staf3, Angelique Flöter Rådestad4, Kenny A Rodriguez-Wallberg5. 1. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden. 2. Department of Obstetrics and Gynecology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. 3. Regional Cancer Center Western Sweden, Sahlgrenska University Hospital, Gothenburg, Sweden. 4. Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden. 5. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Gynecology, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden. Electronic address: kenny.rodriguez-wallberg@ki.se.
Abstract
OBJECTIVE: To assess the efficacy of fertility-sparing surgery (FSS) in terms of reproductive outcomes by following FSS for borderline ovarian tumors (BOTs) and comparing the safety of FSS versus radical surgery (RS). DESIGN: Nationwide cohort study based on prospectively recorded data. SETTING: Sweden. PATIENT (S): All women of reproductive age (18-40 years) treated in Sweden for stage I BOT with the use of FSS or RS from 2008 to 2015, identified in the Swedish Quality Registry for Gynecologic Cancer (SQRGC). INTERVENTIONS (S): FSS or RS. MAIN OUTCOME MEASURE (S): Reproductive outcomes: natural conception, use of assisted reproductive technology (ART), live birth and obstetrical outcomes. Safety outcome: overall survival (OS) rates, comparing women undergoing FSS versus RS. The FSS cohort was linked to the Swedish Medical Birth Register to identify all women who had given birth after FSS and to obtain detailed obstetrical data. For information on ART treatment, the National Quality Registry for Assisted Reproduction was consulted. OS rate comparisons were conducted by means of Kaplan-Meier estimates. RESULT (S): Of the 277 women with BOTs, 213 (77%) underwent FSS, 183 (86%) unilateral salpingo-oophorectomy, and 30 (14%) cystectomy. Following FSS, 50 women gave birth to 62 healthy children, 8% of which were preterm. Only 20 (9%) of the women underwent ART treatment. OS was similar in women treated with FSS and RS. CONCLUSION (S): Natural fertility was maintained after FSS; only 9% required ART treatment. FSS was also deemed to be equivalent to RS regarding survival outcome.
OBJECTIVE: To assess the efficacy of fertility-sparing surgery (FSS) in terms of reproductive outcomes by following FSS for borderline ovarian tumors (BOTs) and comparing the safety of FSS versus radical surgery (RS). DESIGN: Nationwide cohort study based on prospectively recorded data. SETTING: Sweden. PATIENT (S): All women of reproductive age (18-40 years) treated in Sweden for stage I BOT with the use of FSS or RS from 2008 to 2015, identified in the Swedish Quality Registry for Gynecologic Cancer (SQRGC). INTERVENTIONS (S): FSS or RS. MAIN OUTCOME MEASURE (S): Reproductive outcomes: natural conception, use of assisted reproductive technology (ART), live birth and obstetrical outcomes. Safety outcome: overall survival (OS) rates, comparing women undergoing FSS versus RS. The FSS cohort was linked to the Swedish Medical Birth Register to identify all women who had given birth after FSS and to obtain detailed obstetrical data. For information on ART treatment, the National Quality Registry for Assisted Reproduction was consulted. OS rate comparisons were conducted by means of Kaplan-Meier estimates. RESULT (S): Of the 277 women with BOTs, 213 (77%) underwent FSS, 183 (86%) unilateral salpingo-oophorectomy, and 30 (14%) cystectomy. Following FSS, 50 women gave birth to 62 healthy children, 8% of which were preterm. Only 20 (9%) of the women underwent ART treatment. OS was similar in women treated with FSS and RS. CONCLUSION (S): Natural fertility was maintained after FSS; only 9% required ART treatment. FSS was also deemed to be equivalent to RS regarding survival outcome.
Authors: Jonathan Gaughran; Hannah Rosen O'Sullivan; Tom Lyne; Ahmed Abdelbar; Mostafa Abdalla; Ahmad Sayasneh Journal: J Clin Med Date: 2022-06-03 Impact factor: 4.964
Authors: Luigi Della Corte; Antonio Mercorio; Paolo Serafino; Francesco Viciglione; Mario Palumbo; Maria Chiara De Angelis; Maria Borgo; Cira Buonfantino; Marina Tesorone; Giuseppe Bifulco; Pierluigi Giampaolino Journal: Front Surg Date: 2022-08-23