Conservative Surgery In Epithelial Ovarian Carcinoma: Analysis Of 13 Cases

Objective:Younger patients with epithelial ovarian carcinoma(EOC) frequently want to preserve their fertility,but the role of conservative surgery in EOC was not definite.We therefore assessed ages,histological subtypes,FIGO stages,tumor recurrence,patient survival,pregnancy outcomes and ovarian function in the younger patients with EOC who underwent conservative surgery in order to investigate the feasibility and outcomes of the conservative surgery in the younger patients with EOC.Methods:Patients with EOC in Women's Hospital,School of Medicine, Zhejiang University between Oct.2000 to Sep.2005 who accorded with the conditions as follow were studied:①diagnose with the epithelial ovarian carcinoma in histology and pathology;②younger patients who wished to maintain reproductive capability;③patients who underwent conservative surgery.Conservative surgery was defined as a surgical procedure with conservation of the uterus and at least part of one ovary.The clinicopathologic characteristics including ages,FIGO stages,cell differentiation, histology types,surgery,adjuvant chemotherapy and whether underwent the second surgery etc.were reviewed.Followed up was done using the physical examination, B-mode ultrasonography of pelvis and blood CA125,the patients' menstruation, pregnancies were also followed up.13 patients were identified and included in the study (all the patients were≤35 years old.Their mean age was 27.9 years(range 20-35 years).The beginning of followed-up was the time of first surgery with pathologically confirmed,the termination of followed-up was Dec.2008.Median followed-up was 66.6 months(range,38-97 months),the rate of followed-up was 61.5%.Results:Of the 13 EOCs,7(53.8%) were stage I a,5(38.5%) were stage I c,and 1 was stage IIIa;All the ovarian epithelial carcinoma patients were well-differentiated(G 1).Histologic diagnoses were as follows:mucous cystadenocarcinoma(10 cases,76.9%),serous cystadenocarcinoma(1 case,7.7%),mixed (serous and mucous cystadenocarcinoma 2 cases,15.4%).At diagnosis,12 cases had their site of tumors in the unilateral ovary,3 cases in the left ovary,9 cases in the right ovary,and 1 case(7.7%)in the bilateral ovaries.All the patients received conservative surgery on the first operation,12 cases with their site of tumors in the unilateral ovary were treated by unilateral oophorectomy and omentectomy,6 out of 12 patients accepted the opposite side ovary sampling or the tumor divesting,2 of 12 accepted the appendectomy meanwhile,and 1 case received the lymph-node sampling at the same time.The others who did not received the lymph-node sampling received the careful exploration in pelvis cavity and the abdominal paraaortic lymph nodes were not intumescent.The patient whose tumors in the bilateral ovaries had pregnancy for five months when the primary surgery,the surgery was right adnexectomy+ left tubal resection+ left ovarian mero-oophorectomy.Histologic diagnoses after the surgry was the bilateral ovarian mucous papillary cystadenocarcinoma.She received PC regime adjuvant chemotherapy for 1 cycle after childbearing,and accepted the prophylactic total hysterectomy+ heterolateral oophorectomy+ omentectomy.Then she received PC regime postoperative adjuvant chemotherapy for 4 cycles.In the 13 cases,12 patients received platinum-based adjuvant chemotherapy(mean 4.4 cycles,range 2-9 cycles),the other one was unknown.In the 8 patients who had already been followed-up,7 patients (87.5%) were alive without disease,1 patient(12.5%) had tumor recurrence and lived with disease,0 died of disease.7 patients(87.5%) had normal menstruation.5 women (62.5%) attempted to conceive,and there were 4(50%)term pregnancies in 5 women, with no congenital anomalies was reported in any of these pregnancies.Conclusion:1.Stage I a,G1 epithelial ovarian carcinoma patients who desire to maintain their fertility can be treated safely with conservative surgery,but stage I c should be determined with great cautions.2.The adverse effect of adjuvant chemotherapy isn't very severe on the ovarian function of the younger patients with epithelial ovarian carcinoma who have received the conservative surgery.