Fertility-sparing surgery in patients with advanced borderline ovarian tumors.

OBJECTIVE

Data on fertility-sparing surgery in advanced borderline ovarian tumors are limited to retrospective series and suggest concerning fertility outcomes. We aimed to study the long-term fertility and reproductive outcomes of patients with stage IIA to IIIC borderline ovarian tumors treated with fertility-sparing surgery.

METHODS

This retrospective single-institution study included patients younger than 45 years with stage IIA to IIIC borderline ovarian tumors treated with fertility-sparing surgery from 1985 to 2021. Primary end points were the rates of pregnancies and live births among women attempting to conceive. Logistic regression models were used to evaluate the impact of different covariates on the occurrence of pregnancies.

RESULTS

A total of 86 patients were included in the study. The median follow-up was 182 months. Fifty patients (58%) actively attempted to conceive, 5 of whom were referred to a reproductive medicine center. Forty-two patients successfully achieved 76 pregnancies, and 63 live births occurred in 40 women, yielding an overall pregnancy and live birth rates of 84% and 80%, respectively. Of the 76 pregnancies, 40 occurred before any relapse, while 28 and 8 occurred after the first and second recurrences, respectively. Similarly, of the 63 live births, 35 occurred before any relapse, whereas 22 and 6 occurred after the first and second recurrences. Thirty-five (40.7%) patients underwent subsequent radical surgery, 29 for recurrence and 6 as completion surgery, after a median time of 96 months. The median age at radical surgery was 40 years. Among patients who did not undergo radical surgery, 11 experienced spontaneous menopause during follow-up at a median age of 41 years.

CONCLUSIONS

Despite high recurrence rates, fertility-sparing surgery yields satisfactory fertility outcomes in patients with advanced borderline ovarian tumors, irrespective of disease stage or surgical approach, and should be considered both as a primary treatment strategy and as a feasible option for recurrent disease.