Hill Breana L, Moroney Marisa R, Post Miriam D, Sawyer Brandon, Sheeder Jeanelle, Wolsky Rebecca J, Lefkowits Carolyn
Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, United States.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, United States.
Gynecol Oncol Rep. 2021 Feb 12;36:100730. doi: 10.1016/j.gore.2021.100730. eCollection 2021 May.
Forgoing hysterectomy as part of borderline ovarian tumor (BOT) staging is considered appropriate for fertility preservation. We evaluated whether forgoing hysterectomy may also be acceptable in non-fertility-sparing surgery by evaluating the frequency of uterine involvement and the rate of recurrence involving the uterus. A review of all BOTs at one institution over ten years (2009-2019) was performed. Patients with hysterectomy prior to BOT diagnosis were excluded. Data were abstracted from electronic medical records. Bivariate statistics were used to compare groups. 129 patients with BOT on final pathology were identified. 67 cases included hysterectomy. Reasons for no hysterectomy (n = 62) included fertility preservation (40), benign intraoperative frozen pathology (4), patient preference (3), comorbidities (7), and unknown (8). Four of 67 (6.0%) uterine specimens had non-invasive serosal implants, of which two had grossly visible uterine involvement and all four had grossly visible extrauterine peritoneal disease. 12 of 129 (9.3%) patients had documented recurrence, of which all had uterine preservation at the time of initial surgery. Of the 12 recurrences with uterus in situ, none were documented to involve the uterus, and all were composed of non-invasive implants. In patients with BOT grossly confined to ovaries at the time of surgery, we found no cases of uterine involvement. We found no cases in which microscopic uterine serosal involvement changed stage and no cases of recurrence involving the uterus. Hysterectomy may be able to be safely excluded from non-fertility-sparing surgery for BOTs, particularly when disease is grossly confined to the ovaries.
作为交界性卵巢肿瘤（BOT）分期的一部分，放弃子宫切除术被认为适合保留生育功能。我们通过评估子宫受累频率和子宫复发率，来评估在非保留生育功能手术中放弃子宫切除术是否也可接受。对某一机构10年（2009 - 2019年）内的所有BOT病例进行了回顾。排除在BOT诊断前已行子宫切除术的患者。数据从电子病历中提取。采用双变量统计比较各组。最终病理诊断为BOT的患者有129例。其中67例包括子宫切除术。未行子宫切除术的原因（n = 62）包括保留生育功能（40例）、术中冰冻病理为良性（4例）、患者偏好（3例）、合并症（7例）及原因不明（8例）。67例子宫标本中有4例（6.0%）有非侵袭性浆膜种植，其中2例子宫有肉眼可见的受累，4例均有肉眼可见的子宫外腹膜疾病。129例患者中有12例（9.3%）有复发记录，其中所有患者在初次手术时均保留了子宫。在12例原位子宫复发患者中，无记录显示子宫受累，所有复发均由非侵袭性种植组成。在手术时BOT大体上局限于卵巢的患者中，我们未发现子宫受累病例。我们未发现显微镜下子宫浆膜受累改变分期的病例，也未发现子宫复发的病例。对于BOT的非保留生育功能手术，子宫切除术或许可以安全地省略，尤其是当疾病大体上局限于卵巢时。
