Fertility sparing surgery in gynecological cancers: A review of current state

Abstract

Options in preserving fertility-surgery (FSS) in early-stage gynecological cancers are becoming more widespread as evidence supporting acceptable oncological and reproductive outcomes in well-selected patients continues to grow. It is crucial to thoroughly evaluate individuals' fertility potential before selecting surgical options. Fertility-sparing treatment of endometrial cancer (EC) is considered in cases confined to endometrium. Hormone therapy is considered an absolute treatment and hysteroscopic resection, particularly using the 'grasping' technique, being a preferred method. Cervical cancer (CC) is usually diagnosed in patients during their reproductive years, hence FSS is extremely crucial for their treatment. Patients with early stage, low-risk CC and a tumor size ≤ 2 cm, FSS options are available for preserving their fertility, including conization or simple/radical trachelectomy with pelvic lymph node assessment. A vaginal, abdominal or minimally invasive approach can be used to perform a trachelectomy. Epithelial ovarian cancer (EOC) rarely allows for FSS; however, it may be considered in specific cases, such as stage IA low-grade tumors. Unilateral salpingo-oophorectomy (USO) and comprehensive surgical staging are integral components of FSS in EOC. Non-epithelial ovarian cancers, including germ cell tomors are common in young women, FSS is the main treatment option. Borderline ovarian tumors (BOT) present challenges due to recurrence risks, and the choice between cystectomy and salpingo-oophorectomy is discussed.

Keywords

• Fertility sparing surgery
• endometrial cancer
• ovarian cancer
• cervical cancer

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