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August 8, 2016
Conservative treatment to preserve fertility in ovarian cancer can be safely performed for stage IA and IC grade 1 and 2 disease and stage IC1 according to the new FIGO staging system. For patients with "less favourable" prognostic factors (grade 3, stage IC3 disease, clear cell tumour), the safety of FSS could not be confirmed but patients should be informed that radical treatment probably may not necessarily improve their oncological outcome. FSS should remain contraindicated for stage II/III disease (whatever the histologic subtype).Introduction
Fertility-sparing surgery (FSS) of epithelial ovarian cancer (EOC) is based on unilateral (salpingo-)oophorectomy and complete surgical staging. This empirical treatment option had initially been proposed to young women presenting with an early-stage invasive tumour and a low risk of recurrence [1]. The first large series specifically devoted to this management was published nearly 5 decades ago (mixing different subtypes of ovarian tumours)[2]. Different publications, initially mixing different subtypes (EOC and borderline tumours and/or epithelial and non-epithelial cancers) and more recently specifically dedicated to EOC, have been reported [3-6]. Five years ago, international recommendations were finalized concerning the indications and modalities for FSS in EOC [7].
Nevertheless, many questions continue to fuel debate and remain unclear concerning this management. These questions concern oncological outcomes and fertility issues. The fertility issues will not be covered in the present review most debatable and strategic (and finally philosophical) questions concern the oncological issues......
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