European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2013
Comprehensive study of ovarian metastases in young women with peritoneal pseudomyxoma: is a preservation of fertility possible?
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Elias D, Duchalais E, David A, Dartigues P, Duvillard P, Poirot C, Goéré D
Аннотация
OBJECTIVE: To determine whether ovaries can be preserved in selected young women with peritoneal pseudomyxoma (PMP).
BACKGROUND DATA: The traditional rule is to systematically perform a bilateral oophorectomy.
PATIENTS AND METHODS: A new policy was developed to preserve the ovaries when they are macroscopically normal in young women with PMP, strongly desiring a future pregnancy.
RESULTS: Thirty-three women younger than 41 years were selected after undergoing complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for PMP. A normal ovary was preserved in 6 of them, but in 6 of the 14 women who strongly desired a future pregnancy. Subsequently, ovarian preservation was only performed in cases of grade-1 PMP. Ovarian invasion was correlated with the grade (p < 0.05) and with the extent of peritoneal disease (p < 0.01). After a median follow-up of 54 months, none of the 6 women with preserved ovaries has developed an ovarian or a peritoneal recurrence. One woman became pregnant and egg harvesting and cryopreservation were performed for 4 women with a partially normal ovary.
CONCLUSION: This new policy allowed ovarian preservation in 43% of the young women desiring a future pregnancy and has already resulted in one birth. It exclusively concerned low-grade PMP. Recurrence in the preserved ovary was 0% with our selection criteria.
BACKGROUND DATA: The traditional rule is to systematically perform a bilateral oophorectomy.
PATIENTS AND METHODS: A new policy was developed to preserve the ovaries when they are macroscopically normal in young women with PMP, strongly desiring a future pregnancy.
RESULTS: Thirty-three women younger than 41 years were selected after undergoing complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for PMP. A normal ovary was preserved in 6 of them, but in 6 of the 14 women who strongly desired a future pregnancy. Subsequently, ovarian preservation was only performed in cases of grade-1 PMP. Ovarian invasion was correlated with the grade (p < 0.05) and with the extent of peritoneal disease (p < 0.01). After a median follow-up of 54 months, none of the 6 women with preserved ovaries has developed an ovarian or a peritoneal recurrence. One woman became pregnant and egg harvesting and cryopreservation were performed for 4 women with a partially normal ovary.
CONCLUSION: This new policy allowed ovarian preservation in 43% of the young women desiring a future pregnancy and has already resulted in one birth. It exclusively concerned low-grade PMP. Recurrence in the preserved ovary was 0% with our selection criteria.
Предметные рубрики MeSH
AdolescentAdultChemotherapy, Cancer, Regional PerfusionCombined Modality TherapyDisease-Free SurvivalFemaleFertility PreservationHumansNeoplasm InvasivenessNeoplasm StagingOrgan Sparing TreatmentsOvarian NeoplasmsOvariectomyPatient SelectionPeritoneal NeoplasmsPeritoneumPregnancyPrognosisPseudomyxoma PeritoneiRisk AssessmentSurvival AnalysisYoung Adult