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Outcomes of Fertility Sparing Surgery for Borderline Ovarian Tumors

Year 2024, , 52 - 58, 09.06.2024
https://doi.org/10.46969/EZH.1476817

Abstract

Aim: The aim of this study was to investigate the results of fertility-preserving and/or radical surgery, the effects of fertility-preserving surgery on fertility and the postoperative recurrence rate in patients with borderline ovarian tumors.
Material and Method: The study included 138 patients who were diagnosed with borderline ovarian tumors in the oncology clinic of a tertiary institution in Ankara. The patients’ data were analyzed retrospectively from the hospital information system. Among 138 patients, age, parity, type of surgery, number of lymph nodes removed, recurrence rates, pregnancy rates after treatment and fertility and recurrence analysis were performed. Recurrence and fertility rates were compared between those who underwent fertility preserving surgery and those who did not.
Results: The distribution of the patıents’ age groups is as follows: 21% of the patients were under the age of 30; 26.1% were between 31-40 years of age, and 21% were between 41-50 years of age. The BMI data of the patients shows that 20.3% of the patients were in normal weight, on the contrary, 44.9% were overweight (25 kg/m2 to 29.9 kg/m2). According to the pathology results of the patients, 63% (n=87) were serous, 31.9% (n=44) mucinous, 5.1% (n=7) endometrioid type borderline ovarian tumors. Spontaneous pregnancy was observed in 31% (n=18) and pregnancy as a result of assisted reproductive techniques in 5.2% (n=3) of the patients who underwent fertility preserving surgery. According to the results of the study, it is observed that there is a statistical relationship between recurrence and fertility preservation. Recurrence was observed in 2.5% (n=2) of the individuals whose fertility was not preserved while recurrence was observed in 24.1% (n=14) of individuals whose fertility was preserved. Although it was observed that recurrence increased in patients who underwent fertility preservation surgery, it allowed pregnancy to be achieved at a rate of approximately 36%.
Conclusion: Since patients with borderline ovarian tumours are younger than patients with invasive ovarian cancer, fertility-sparing surgery is becoming increasingly important.

References

  • Silverberg SG, Bell DA, Kurman RJ, et al. Borderline ovarian tumors: key points and workshop summary. Hum Pathol. 2004;35(8):910-7. https://doi.org/10.1016/j.humpath.2004.03.003
  • Classification and staging of malignant tumours in the female pelvis. Acta Obstet Gynecol Scand. 1971;50(1):1-7. https://doi.org/10.3109/00016347109157278
  • Serov SS, Scully RE, Sobin LH, editors. Histological typing of ovarian tumors. Geneva: Springer, Berlin Heidelberg New York for WHO; 1973.
  • Tavassoli FA, Devilee P, editors. Pathology and genetics of tumours of the breast and female genital organs. Lyon: IARC Press; 2003.
  • Kurman RJ, Carcangiu ML, Herrington CS, Young RHE, editors. WHO classification of tumours of female reproductive organs. IARC: Lyon; 2014.
  • Hauptmann S, Friedrich K, Redline R, Avril S. Ovarian borderline tumors in the 2014 WHO classification: evolving concepts and diagnostic criteria. Virchows Arch. 2017;470(2):125-42. https://doi.org/10.1007/s00428-016-2040-8
  • Gungor T, Cetinkaya N, Yalcin H, et al. Retrospective evaluation of borderline ovarian tumors: single center experience of 183 cases. Arch Gynecol Obstet. 2015;291(1):123-30. https://doi.org/10.1007/s00404-014-3381-7
  • Kanat-Pektas M, Ozat M, Gungor T, Sahin I, Yalcin H, Ozdal B. Complete lymph node dissection: is it essential for the treatment of borderline epithelial ovarian tumors?. Arch Gynecol Obstet. 2011;283(4):879-84. https://doi.org/10.1007/s00404-010-1539-5
  • Zhao J, Liu C, Liu J, Qu P. Short-term Outcomes and Pregnancy Rate After Laparoscopic Fertility-Sparing Surgery for Borderline Ovarian Tumors: A Single-Institute Experience. Int J Gynecol Cancer. 2018;28(2):274-8. https://doi.org/10.1097/IGC.0000000000001170
  • Coumbos A, Sehouli J, Chekerov R, et al. Clinical management of borderline tumours of the ovary: results of a multicentre survey of 323 clinics in Germany. Br J Cancer. 2009;100(11):1731-8. https://doi.org/10.1038/sj.bjc.6605065
  • Pecorino B, Laganà AS, Mereu L, et al. Evaluation of Borderline Ovarian Tumor Recurrence Rate after Surgery with or without Fertility-Sparing Approach: Results of a Retrospective Analysis. Healthcare (Basel). 2023;11(13):1922. https://doi.org/10.3390/healthcare11131922
  • Cang W, Liang C, Wang D, et al. Oncological and Reproductive Outcomes after Fertility-Sparing Surgery in Patients with Advanced-Stage Serous Borderline Ovarian Tumor: A Single-Center Retrospective Study. J Clin Med. 2023;12(18):5827. https://doi.org/10.3390/jcm12185827
  • Skírnisdóttir I, Garmo H, Wilander E, Holmberg L. Borderline ovarian tumors in Sweden 1960-2005: trends in incidence and age at diagnosis compared to ovarian cancer. Int J Cancer. 2008;123(8):1897-901. https://doi.org/10.1002/ijc.23724
  • Boran N, Cil AP, Tulunay G, et al. Fertility and recurrence results of conservative surgery for borderline ovarian tumors. Gynecol Oncol. 2005;97(3):845-51. https://doi.org/10.1016/j.ygyno.2005.03.010
  • Tinelli R, Tinelli A, Tinelli FG, Cicinelli E, Malvasi A. Conservative surgery for borderline ovarian tumors: a review. Gynecol Oncol. 2006;100(1):185-91. https://doi.org/10.1016/j.ygyno.2005.09.021
  • Fan Y, Zhang YF, Wang MY, Mu Y, Mo SP, Li JK. Influence of lymph node involvement or lymphadenectomy on prognosis of patients with borderline ovarian tumors: A systematic review and meta-analysis. Gynecol Oncol. 2021;162(3):797-803. https://doi.org/10.1016/j.ygyno.2021.05.033
  • Camatte S, Morice P, Thoury A, et al. Impact of surgical staging in patients with macroscopic “stage I” ovarian borderline tumours: analysis of a continuous series of 101 cases. Eur J Cancer. 2004;40(12):1842-9. https://doi.org/10.1016/j.ejca.2004.04.017
  • Rao GG, Skinner E, Gehrig PA, Duska LR, Coleman RL, Schorge JO. Surgical staging of ovarian low malignant potential tumors. Obstet Gynecol. 2004;104(2):261-6. https://doi.org/10.1097/01.AOG.0000133484.92629.88
  • Donnez J, Munschke A, Berliere M, et al. Safety of conservative management and fertility outcome in women with borderline tumors of the ovary. Fertil Steril. 2003;79(5):1216-21. https://doi.org/10.1016/s0015-0282(03)00160-2
  • Lou T, Yuan F, Feng Y, Wang S, Bai H, Zhang Z. The safety of fertility and ipsilateral ovary procedures for borderline ovarian tumors. Oncotarget. 2017;8(70):115718-29. https://doi.org/10.18632/oncotarget.23021
  • Romagnolo C, Gadducci A, Sartori E, Zola P, Maggino T. Management of borderline ovarian tumors: results of an Italian multicenter study. Gynecol Oncol. 2006;101(2):255-60. https://doi.org/10.1016/j.ygyno.2005.10.014
  • Zanetta G, Rota S, Chiari S, Bonazzi C, Bratina G, Mangioni C. Behavior of borderline tumors with particular interest to persistence, recurrence, and progression to invasive carcinoma: a prospective study. J Clin Oncol. 2001;19(10):2658-64. https://doi.org/10.1200/JCO.2001.19.10.2658
  • Vasconcelos I, de Sousa Mendes M. Conservative surgery in ovarian borderline tumours: a meta-analysis with emphasis on recurrence risk. Eur J Cancer. 2015;51(5):620-31. https://doi.org/10.1016/j.ejca.2015.01.004
  • Gotlieb WH, Flikker S, Davidson B, Korach Y, Kopolovic J, Ben-Baruch G. Borderline tumors of the ovary: fertility treatment, conservative management, and pregnancy outcome. Cancer. 1998;82(1):141-6.
  • Morice P, Camatte S, El Hassan J, Pautier P, Duvillard P, Castaigne D. Clinical outcomes and fertility after conservative treatment of ovarian borderline tumors. Fertil Steril. 2001;75(1):92-6. https://doi.org/10.1016/s0015-0282(00)01633-2
  • Plett H, Harter P, Ataseven B, et al. Fertility-sparing surgery and reproductive-outcomes in patients with borderline ovarian tumors. Gynecol Oncol. 2020;157(2):411-7. https://doi.org/10.1016/j.ygyno.2020.02.007

Borderline Over Tümörlerinde Fertilite Koruyucu Cerrahi Sonuçları

Year 2024, , 52 - 58, 09.06.2024
https://doi.org/10.46969/EZH.1476817

Abstract

Amaç: Bu çalışmanın amacı borderline over tümörüne sahip hastalarda fertilite koruyucu ve/veya radikal cerrahilerin sonuçlarını, fertilite koruyucu cerrahinin fertilite üzerine etkisini ve postoperatif nüks oranlarını araştırmaktır.
Gereç ve Yöntem: Çalışmaya Ankara’da yer alan 3. basamak bir sağlık kuruluşunun onkoloji kliniğinde borderline over tümörü tanısı alan 138 hasta dahil edildi. Hastaların verileri hastane bilgi sisteminden retrospektif olarak analiz edilmiştir. 138 hastanın yaş, parite, ameliyat tipi, çıkarılan lenf nodu sayısı, nüks oranları, tedavi sonrası gebelik oranları ve doğurganlık ve nüks analizleri yapıldı. Nüks ve fertilite oranları fertilite koruyucu cerrahi uygulananlar ve uygulanmayanlar arasında karşılaştırıldı.
Bulgular: Hastaların yaş gruplarına göre dağılımı aşağıdaki gibidir: Hastaların %21’i 30 yaşın altında; %26,1’i 31-40 yaş arasında ve %21’i 41-50 yaş arasındadır. Hastaların VKİ verileri, hastaların %20,3’ünün normal kiloda olduğunu, buna karşılık %44,9’unun aşırı kilolu (25 kg/m2 ila 29,9 kg/m2) olduğunu göstermektedir. Hastaların patoloji sonuçlarına göre %63’ü (n=87) seröz, %31,9’u (n=44) müsinöz, %5,1’i (n=7) endometrioid tip borderline over tümörüdür. Fertilite koruyucu cerrahi uygulanan hastaların %31’inde (n=18) spontan gebelik, %5,2’sinde (n=3) ise yardımcı üreme teknikleri sonucu gebelik gözlendi. Çalışma sonuçlarına göre, nüks ile fertilite koruma arasında istatistiksel bir ilişki olduğu görülmektedir. Fertilitesi korunmayan bireylerin %2,5’inde (n=2) nüks gözlenirken, fertilitesi korunan bireylerin %24,1’inde (n=14) nüks gözlenmiştir. Fertilite koruma cerrahisi uygulanan hastalarda nüksün arttığı gözlense de yaklaşık %36 oranında gebelik elde edilmesine olanak sağlamıştır.
Sonuç: Borderline over tümörlü hastalar invaziv over kanserli hastalardan daha genç olduğundan, fertilite koruyucu cerrahi giderek daha önemli hale gelmektedir.

References

  • Silverberg SG, Bell DA, Kurman RJ, et al. Borderline ovarian tumors: key points and workshop summary. Hum Pathol. 2004;35(8):910-7. https://doi.org/10.1016/j.humpath.2004.03.003
  • Classification and staging of malignant tumours in the female pelvis. Acta Obstet Gynecol Scand. 1971;50(1):1-7. https://doi.org/10.3109/00016347109157278
  • Serov SS, Scully RE, Sobin LH, editors. Histological typing of ovarian tumors. Geneva: Springer, Berlin Heidelberg New York for WHO; 1973.
  • Tavassoli FA, Devilee P, editors. Pathology and genetics of tumours of the breast and female genital organs. Lyon: IARC Press; 2003.
  • Kurman RJ, Carcangiu ML, Herrington CS, Young RHE, editors. WHO classification of tumours of female reproductive organs. IARC: Lyon; 2014.
  • Hauptmann S, Friedrich K, Redline R, Avril S. Ovarian borderline tumors in the 2014 WHO classification: evolving concepts and diagnostic criteria. Virchows Arch. 2017;470(2):125-42. https://doi.org/10.1007/s00428-016-2040-8
  • Gungor T, Cetinkaya N, Yalcin H, et al. Retrospective evaluation of borderline ovarian tumors: single center experience of 183 cases. Arch Gynecol Obstet. 2015;291(1):123-30. https://doi.org/10.1007/s00404-014-3381-7
  • Kanat-Pektas M, Ozat M, Gungor T, Sahin I, Yalcin H, Ozdal B. Complete lymph node dissection: is it essential for the treatment of borderline epithelial ovarian tumors?. Arch Gynecol Obstet. 2011;283(4):879-84. https://doi.org/10.1007/s00404-010-1539-5
  • Zhao J, Liu C, Liu J, Qu P. Short-term Outcomes and Pregnancy Rate After Laparoscopic Fertility-Sparing Surgery for Borderline Ovarian Tumors: A Single-Institute Experience. Int J Gynecol Cancer. 2018;28(2):274-8. https://doi.org/10.1097/IGC.0000000000001170
  • Coumbos A, Sehouli J, Chekerov R, et al. Clinical management of borderline tumours of the ovary: results of a multicentre survey of 323 clinics in Germany. Br J Cancer. 2009;100(11):1731-8. https://doi.org/10.1038/sj.bjc.6605065
  • Pecorino B, Laganà AS, Mereu L, et al. Evaluation of Borderline Ovarian Tumor Recurrence Rate after Surgery with or without Fertility-Sparing Approach: Results of a Retrospective Analysis. Healthcare (Basel). 2023;11(13):1922. https://doi.org/10.3390/healthcare11131922
  • Cang W, Liang C, Wang D, et al. Oncological and Reproductive Outcomes after Fertility-Sparing Surgery in Patients with Advanced-Stage Serous Borderline Ovarian Tumor: A Single-Center Retrospective Study. J Clin Med. 2023;12(18):5827. https://doi.org/10.3390/jcm12185827
  • Skírnisdóttir I, Garmo H, Wilander E, Holmberg L. Borderline ovarian tumors in Sweden 1960-2005: trends in incidence and age at diagnosis compared to ovarian cancer. Int J Cancer. 2008;123(8):1897-901. https://doi.org/10.1002/ijc.23724
  • Boran N, Cil AP, Tulunay G, et al. Fertility and recurrence results of conservative surgery for borderline ovarian tumors. Gynecol Oncol. 2005;97(3):845-51. https://doi.org/10.1016/j.ygyno.2005.03.010
  • Tinelli R, Tinelli A, Tinelli FG, Cicinelli E, Malvasi A. Conservative surgery for borderline ovarian tumors: a review. Gynecol Oncol. 2006;100(1):185-91. https://doi.org/10.1016/j.ygyno.2005.09.021
  • Fan Y, Zhang YF, Wang MY, Mu Y, Mo SP, Li JK. Influence of lymph node involvement or lymphadenectomy on prognosis of patients with borderline ovarian tumors: A systematic review and meta-analysis. Gynecol Oncol. 2021;162(3):797-803. https://doi.org/10.1016/j.ygyno.2021.05.033
  • Camatte S, Morice P, Thoury A, et al. Impact of surgical staging in patients with macroscopic “stage I” ovarian borderline tumours: analysis of a continuous series of 101 cases. Eur J Cancer. 2004;40(12):1842-9. https://doi.org/10.1016/j.ejca.2004.04.017
  • Rao GG, Skinner E, Gehrig PA, Duska LR, Coleman RL, Schorge JO. Surgical staging of ovarian low malignant potential tumors. Obstet Gynecol. 2004;104(2):261-6. https://doi.org/10.1097/01.AOG.0000133484.92629.88
  • Donnez J, Munschke A, Berliere M, et al. Safety of conservative management and fertility outcome in women with borderline tumors of the ovary. Fertil Steril. 2003;79(5):1216-21. https://doi.org/10.1016/s0015-0282(03)00160-2
  • Lou T, Yuan F, Feng Y, Wang S, Bai H, Zhang Z. The safety of fertility and ipsilateral ovary procedures for borderline ovarian tumors. Oncotarget. 2017;8(70):115718-29. https://doi.org/10.18632/oncotarget.23021
  • Romagnolo C, Gadducci A, Sartori E, Zola P, Maggino T. Management of borderline ovarian tumors: results of an Italian multicenter study. Gynecol Oncol. 2006;101(2):255-60. https://doi.org/10.1016/j.ygyno.2005.10.014
  • Zanetta G, Rota S, Chiari S, Bonazzi C, Bratina G, Mangioni C. Behavior of borderline tumors with particular interest to persistence, recurrence, and progression to invasive carcinoma: a prospective study. J Clin Oncol. 2001;19(10):2658-64. https://doi.org/10.1200/JCO.2001.19.10.2658
  • Vasconcelos I, de Sousa Mendes M. Conservative surgery in ovarian borderline tumours: a meta-analysis with emphasis on recurrence risk. Eur J Cancer. 2015;51(5):620-31. https://doi.org/10.1016/j.ejca.2015.01.004
  • Gotlieb WH, Flikker S, Davidson B, Korach Y, Kopolovic J, Ben-Baruch G. Borderline tumors of the ovary: fertility treatment, conservative management, and pregnancy outcome. Cancer. 1998;82(1):141-6.
  • Morice P, Camatte S, El Hassan J, Pautier P, Duvillard P, Castaigne D. Clinical outcomes and fertility after conservative treatment of ovarian borderline tumors. Fertil Steril. 2001;75(1):92-6. https://doi.org/10.1016/s0015-0282(00)01633-2
  • Plett H, Harter P, Ataseven B, et al. Fertility-sparing surgery and reproductive-outcomes in patients with borderline ovarian tumors. Gynecol Oncol. 2020;157(2):411-7. https://doi.org/10.1016/j.ygyno.2020.02.007
There are 26 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Article
Authors

Dilara Sarıkaya Kurt 0000-0002-1492-0305

Ayse Sinem Duru Çöteli 0000-0002-6558-7549

Ahmet Kurt 0000-0001-8402-5675

Nurettin Boran 0000-0002-0367-5551

Publication Date June 9, 2024
Submission Date May 1, 2024
Acceptance Date May 23, 2024
Published in Issue Year 2024

Cite

APA Kurt, D. S., Duru Çöteli, A. S., Kurt, A., Boran, N. (2024). Outcomes of Fertility Sparing Surgery for Borderline Ovarian Tumors. Türk Kadın Sağlığı Ve Neonatoloji Dergisi, 6(2), 52-58. https://doi.org/10.46969/EZH.1476817
AMA Kurt DS, Duru Çöteli AS, Kurt A, Boran N. Outcomes of Fertility Sparing Surgery for Borderline Ovarian Tumors. Türk Kadın Sağlığı ve Neonatoloji Dergisi. June 2024;6(2):52-58. doi:10.46969/EZH.1476817
Chicago Kurt, Dilara Sarıkaya, Ayse Sinem Duru Çöteli, Ahmet Kurt, and Nurettin Boran. “Outcomes of Fertility Sparing Surgery for Borderline Ovarian Tumors”. Türk Kadın Sağlığı Ve Neonatoloji Dergisi 6, no. 2 (June 2024): 52-58. https://doi.org/10.46969/EZH.1476817.
EndNote Kurt DS, Duru Çöteli AS, Kurt A, Boran N (June 1, 2024) Outcomes of Fertility Sparing Surgery for Borderline Ovarian Tumors. Türk Kadın Sağlığı ve Neonatoloji Dergisi 6 2 52–58.
IEEE D. S. Kurt, A. S. Duru Çöteli, A. Kurt, and N. Boran, “Outcomes of Fertility Sparing Surgery for Borderline Ovarian Tumors”, Türk Kadın Sağlığı ve Neonatoloji Dergisi, vol. 6, no. 2, pp. 52–58, 2024, doi: 10.46969/EZH.1476817.
ISNAD Kurt, Dilara Sarıkaya et al. “Outcomes of Fertility Sparing Surgery for Borderline Ovarian Tumors”. Türk Kadın Sağlığı ve Neonatoloji Dergisi 6/2 (June 2024), 52-58. https://doi.org/10.46969/EZH.1476817.
JAMA Kurt DS, Duru Çöteli AS, Kurt A, Boran N. Outcomes of Fertility Sparing Surgery for Borderline Ovarian Tumors. Türk Kadın Sağlığı ve Neonatoloji Dergisi. 2024;6:52–58.
MLA Kurt, Dilara Sarıkaya et al. “Outcomes of Fertility Sparing Surgery for Borderline Ovarian Tumors”. Türk Kadın Sağlığı Ve Neonatoloji Dergisi, vol. 6, no. 2, 2024, pp. 52-58, doi:10.46969/EZH.1476817.
Vancouver Kurt DS, Duru Çöteli AS, Kurt A, Boran N. Outcomes of Fertility Sparing Surgery for Borderline Ovarian Tumors. Türk Kadın Sağlığı ve Neonatoloji Dergisi. 2024;6(2):52-8.