Fertility sparing surgery in epithelial ovarian cancer in Italy: perceptions, practice, and main issues

Abstract

About 2.7% of patients epithelial ovarian cancers (EOC) are younger than 40 and present with stage I disease. For this subset of women, the issue of fertility sparing surgery (FSS) has become critical. The aim of this survey was to investigate the management of EOC patients desiring to preserve fertility in Italy. A questionnaire consisting of 30 items was developed to evaluate: patient-selection criteria, rate of FSS, patient’s counseling- and pregnancy-timing, fertility preservation, obstetrics, and oncologic outcomes. One expert clinician for each of 50 major gynecologic oncology centers was invited to participate. Data were entered into a database and statistically analyzed. 74% of questionnaires were complete. The proportion of EOC patients treated with FSS was <10%, 10%–20% and >20% in 70.3%, 24.3% and 5.4% of cases, respectively. Age, fertility preservation desire, histotype, and stage were considered relevant to select patients for a conservative treatment for 64.8%, 72.9%, and 78.3% of responders, respectively. Only 17 centers (45.9%) resulted to have an assisted reproductive technique service and Obstetrics Department. Our survey highlights discrepancies among oncologists in the management of patients with early EOC undergoing FSS. More efforts should be made to define and broadcast the best management before and after surgery.

Chinese abstract

上皮性卵巢癌(EOC)约2.7%的患者年龄在40岁以下, 表现为Ⅰ期。对于这部分女性, 保留生育手术(FSS)的问题至关重要。本调查目的旨在调查意大利渴望生育力保护的EOC患者的管理。调查问卷评估由30个项目组成, 包括：患者选择标准、FSS率、患者咨询和怀孕时机、生育力保护、产科和肿瘤结果。50家主要妇科肿瘤学中心各邀请一名临床专家参与。将数据输入数据库并进行统计分析。完成问卷74%。应用FSS治疗的EOC患者<10%、10%∼20%和>20%的比例分别为70.3%、24.3%和5.4%。年龄、生育能力保护愿望, 组织学类型和分级, 与患者选择保守治疗相关, 分别为64.8%, 72.9%和78.3%。仅有17个中心(45.9%)求助于辅助生殖技术和产科。本调查突出了肿瘤学家在EOC患者早期接受FSS管理上的差异。规范和传播术前和术后的最佳管理仍需更多努力。

Keywords:

• Ovarian cancer
• fertility
• pregnancy
• conservative surgery

Disclosure statement

The authors report no conflicts of interest.