A study released at the recent annual meeting of the Society of Gynecologic Oncologists (SGO) challenges the traditional management of ovarian cancer in young women by suggesting that conservative surgery (which often allows for future childbearing) does not decrease survival rates. The objective of this study was to determine the role and safety of fertility-sparing surgery in early-stage invasive epithelial ovarian cancer. The study was conducted by Carol L. Brown,MD, Bhaskaran Dharmendra, MD, and Richard R. Barakat, MD, of the Gynecology Service, Department of Surgery, at Memorial Sloan-Kettering Cancer Center in New York.
The standard management of early ovarian cancer includes hysterectomy and complete removal of the fallopian tubes and ovaries (TAH/BSO [total abdominal hysterectomy/bilateral salpingo-oophorectomy]), abruptly causing menopause and leaving no options for future childbearing, said Dr. Brown, the studys lead author. By using conservative surgery that preserves functioning ovarian tissue and the uterus, we found survival rates comparable to the standard surgery of TAH/BSO in this study.
Study subjects came from a retrospective review of 127 Memorial Sloan-Kettering patients who had undergone surgery for stage I epithelial ovarian cancer between November 1982 and June 1999. Two groups of patients were identified: one group had conservative surgery that preserved the uterus and at least one ovary, while the other group had surgery that removed the uterus and all functioning ovarian tissue. Patients in both groups had undergone complete surgical staging for ovarian cancer that included multiple biopsies of the peritoneum, removal of the omentum, and biopsies from lymph nodes.
Among patients younger than age 40 years, 16 (57%) had surgery that preserved the uterus and opposite ovary. Another 92 patients, 28 to 87 years old, had TAH/BSO. Patient characteristics, stage, grade of cancer, and tumor type were recorded, and patients in the two groups were compared with respect to recurrence of cancer and survival.
In the conservative surgery group, 88% of patients were alive with no evidence of cancer at a median of 7 years after being diagnosed, compared to 77% of the patients who underwent TAH/BSO. Of women who had ovarian preservation, 12% experienced a recurrence of cancer, compared to 15% of those who had both ovaries removed. Among the conservative surgery group survivors in this study, 93% either resumed normal menstrual function or had a successful pregnancy after completing treatment, including the 30% who received chemotherapy after their staging surgery.
Based on their results, Dr. Brown and her coauthors concluded that preserving the uterus and one ovary in selected patients with ovarian cancer after comprehensive staging is feasible and does not decrease survival, compared to patients undergoing standard surgery. In addition, conservative surgery for ovarian cancer preserves normal hormonal function and fertility in young women with early-stage disease.