SAN DIEGOConservative surgery can preserve fertility in young
women with epithelial ovarian cancer and achieve survival rates
comparable to standard surgery (total abdominal hysterectomy and
removal of the fallopian tubes and ovaries), researchers from
Memorial Sloan-Kettering Cancer Center reported at the 31st
annual meeting of the Society of Gynecologic Oncologists (SGO).
These conclusions were based on a retrospective review of 127
patients treated for stage I epithelial ovarian cancer between 1982
and 1999, said lead investigator Carol L. Brown, MD, assistant
attending surgeon, Memorial Sloan-Kettering, and assistant professor
of obstetrics and gynecology, Cornell University Weill Medical
College. All patients had complete surgical staging that included
multiple biopsies of the peritoneum, removal of the omentum, and
lymph node biopsies.
Sixteen patients, all of whom were under age 40 at diagnosis, had
conservative surgery, defined as preservation of the uterus and at
least a portion of one ovary.
Five of the 16 patients (32%) were also treated with adjuvant
platinum-based chemotherapy. The decision to treat with adjuvant
therapy in the conservative-surgery group was based on the presence
of perceived high-risk factors, including grade 2 disease or higher,
adherence to pelvic structures requiring sharp dissection, and
prestaging rupture or drainage of a malignant cyst, Dr. Brown said.
Ninety-two patients, aged 28 to 87, had standard surgery. The choice
of conservative surgery in the study was made by the individual
surgeon based on criteria that included patient age, parity, stage,
grade, and the patients wish to preserve childbearing
The standard management of early ovarian cancer abruptly causes
menopause and leaves no options for future childbearing. Our current
practice is to offer conservative surgery to patients who are of
childbearing age (40 or younger) and who have stage I cancer and a
desire to have children in the future, she said.
Dr. Brown reported that 14 (88%) of the conservative-surgery patients
vs 71 (77%) of the standard-surgery patients were alive with no signs
of disease at median follow-up of 79 months. Two of the
conservative-surgery patients had cancer recurrence in the retained
ovary at 11 and 20 months, and both died of their disease. Fourteen
(15%) patients in the standard-surgery group had a recurrence, and 8
have died of their disease.
In the conservative-surgery group, five patients had a total of eight
successful pregnancies, Dr. Brown said. This included two pregnancies
in women who had received adjuvant chemotherapy. One patient was
treated unsuccessfully for infertility, one was on oral
contraceptives, and the remaining seven patients had regular
The Memorial Sloan-Kettering group would not undertake
conservative surgery in any patient who had ovarian cancer in both
ovaries (stage IB), who had a grade 3 tumor, or who had the
histologic subtype of clear cell cancer, Dr. Brown told ONI
in an interview.
This study did not include patients who had stage II-IV ovarian
cancer, and Dr. Brown said she would not offer this approach to these
patients at present.
She also feels strongly that staging surgery for ovarian cancer
should be performed only by an appropriately trained gynecologic
These findings expand our understanding of ovarian cancer in
two ways, Dr. Brown said. First, the data suggest that
although ovarian cancer is not common in young women, when it does
occur, an option exists to treat the cancer adequately and yet
preserve the womans reproductive ability and hormonal
function. Second, she continued, young women who have
undergone conservative treatment will likely have normal hormonal
function afterwards and can successfully become pregnant and bear
children, even after chemotherapy.