Feasibility and safety of fertility-sparing surgery in epithelial ovarian cancer with dense adhesion: a long-term result from a single institution

• Published in: Journal of gynecologic oncology Vol. 31; no. 6; pp. e85 - 12
• Main Authors: Baek, Min-Hyun, Park, Jeong-Yeol, Kim, Dae-Yeon, Suh, Dae-Shik, Kim, Jong-Hyeok, Kim, Yong-Man, Kim, Young-Tak
• Format: Journal Article
• Language: English
• Published: Korea (South) Asian Society of Gynecologic Oncology; Korean Society of Gynecologic Oncology; Japan Society of Gynecologic Oncology 01.11.2020; 대한부인종양학회
• Subjects: Original; 산부인과학; Ovarian Neoplasms; Tissue Adhesions; Gynecologic Surgery; Fertility Preservation
• ISSN: 2005-0380; 2005-0399; 2005-0399
• DOI: 10.3802/jgo.2020.31.e85

We investigated the feasibility and safety of fertility-sparing surgery (FSS) in patients with epithelial ovarian cancer (EOC) with dense adhesions. Patients were divided into cases with and without dense adhesions in this retrospective study. Of the 95 eligible patients, 29 patients had dense adhesions. Mean age, proportion of staging procedure, distribution of histologic type, and co-presence of endometriosis were different (p=0.003, 0.033, 0.011, and 0.011, respectively). The median follow-up period was 57.8 (0.4-230.0) months. There were no differences in the rates of recurrence (21.2% vs. 20.7%, p=1.000) or death (16.7% vs. 6.9%, p=0.332) between the 2 groups. There was no difference in the pattern of recurrence or in disease-free survival (DFS) and overall survival (OS) between the 2 groups. In multivariate analysis, pretreatment cancer antigen-125 >35 U/mL and International Federation of Gynecology and Obstetrics stage IC were significant factors of worse DFS and OS, while dense adhesion was not a prognostic factor for both DFS (hazard ratio [HR]=0.9; 95% confidence interval [CI]=0.3-2.7; p=0.792) and OS (HR=0.2; 95% CI=0.1-1.8; p=0.142), nor were age, proportion of staging procedure, histologic type, and co-presence of endometriosis. Moreover, the distribution of those 2 significant prognostic factors was not different between the 2 groups. Dense adhesions were subgrouped into non-tumor and tumor associated dense adhesions for further analysis and the results were same. FSS is feasible and safe in EOC, regardless of the presence of dense adhesions.