Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital (Dr. Bercow); Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital (Dr. Bercow), Boston, Massachusetts.
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (Drs. Nitecki and Rauh-Hain), Houston, Texas.
J Minim Invasive Gynecol. 2021 Mar;28(3):527-536.e1. doi: 10.1016/j.jmig.2020.08.018. Epub 2020 Aug 26.
To compare reproductive and oncologic outcomes of patients diagnosed with early-stage epithelial ovarian carcinoma, borderline ovarian tumors, or nonepithelial ovarian carcinoma according to receipt of fertility-sparing surgery or conventional surgery.
PubMed was searched from January 1, 1995, to May 29, 2020.
Studies were included if they (1) enrolled women of childbearing age diagnosed with ovarian cancer between the ages of 18 years and 50 years, (2) reported on oncologic and/or reproductive outcomes after fertility-sparing surgery for ovarian cancer, and (3) included at least 20 patients.
TABULATION, INTEGRATION, AND RESULTS: The initial search identified 995 studies. After duplicates were removed, we abstracted 980 unique citations. Of those screened, 167 publications were identified as potentially relevant, and evaluated for inclusion and exclusion criteria. The final review included 44 studies in epithelial ovarian cancer, 42 in borderline ovarian tumors, and 31 in nonepithelial ovarian carcinoma. The narrative synthesis demonstrated that overall survival does not seem to be compromised in patients undergoing fertility-sparing surgery compared with those undergoing conventional surgery, although long-term data are limited. Areas of controversy include safety of fertility-sparing surgery in the setting of high-risk factors (stage IC, grade 3, and clear cell histology), as well as type of surgery (salpingo-oophorectomy vs cystectomy). It seems that although there may be some fertility compromise after surgery, pregnancy and live-birth rates are encouraging.
Fertility-sparing surgery is safe and feasible in women with early-stage low-risk ovarian cancer. Pregnancy outcomes for these patients also seem to be similar to those of the general population.
比较接受保留生育功能手术或常规手术的早期上皮性卵巢癌、交界性卵巢肿瘤或非上皮性卵巢癌患者的生殖和肿瘤学结局。
从 1995 年 1 月 1 日到 2020 年 5 月 29 日，在 PubMed 上进行了检索。
如果研究（1）纳入年龄在 18 岁至 50 岁之间被诊断患有卵巢癌的育龄妇女，（2）报告了保留生育功能手术治疗卵巢癌的肿瘤学和/或生殖结局，以及（3）纳入至少 20 名患者，则纳入研究。
列表、综合和结果：最初的搜索确定了 995 项研究。去除重复项后，我们提取了 980 条独特的引文。在筛选的这些文章中，有 167 篇被认为与主题相关，并评估了纳入和排除标准。最终的综述包括 44 项上皮性卵巢癌研究、42 项交界性卵巢肿瘤研究和 31 项非上皮性卵巢癌研究。叙述性综合表明，与接受常规手术的患者相比，接受保留生育功能手术的患者的总体生存率似乎没有受到影响，尽管长期数据有限。争议的领域包括在高危因素（IC 期、3 级和透明细胞组织学）下保留生育功能手术的安全性，以及手术类型（输卵管卵巢切除术与囊肿切除术）。尽管手术后可能存在一些生育能力受损，但妊娠和活产率令人鼓舞。
在早期低危卵巢癌女性中，保留生育功能手术是安全可行的。这些患者的妊娠结局似乎也与一般人群相似。
