Download PDF
Semin Reprod Med
DOI: 10.1055/s-0045-1808243
Review Article

Candidates for Fertility-Sparing Surgery in Case of Ovarian Cancer

Myriam Gracia 
1   Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
,
María Alonso-Espías
1   Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
,
Ignacio Zapardiel
1   Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
› Author Affiliations
Funding None.
› Further Information
   Permissions and Reprints

Abstract

Ovarian cancer, a leading cause of gynecological cancer mortality, often affects women of reproductive age. Fertility-sparing surgery (FSS) has emerged as a viable option for selected patients with early-stage ovarian cancer who wish to preserve fertility. Patient and tumor selection criteria focus on preserving ovarian function and reproductive potential without compromising oncological safety. Optimal candidates are young, premenopausal women with disease confined to one ovary and favorable prognostic factors such as early FIGO stage, specific histologic subtypes, and good overall health. FSS typically involves unilateral salpingo-oophorectomy while preserving the uterus and contralateral ovary, achieving survival outcomes comparable to radical surgery in early-stage low-grade tumors. However, its application in higher-risk cases requires cautious evaluation. Multidisciplinary management, involving gynecologic oncologists and reproductive specialists, is essential for successful implementation of FSS, ensuring both oncological safety and preservation of reproductive potential. Long-term follow-up is critical to monitor recurrence and assess reproductive outcomes. Pregnancy after FSS is feasible, with timing guided by cancer type, stage, and individual circumstances. This review summarizes the current knowledge on FSS in ovarian cancer, emphasizing its relevance and the need for further research to refine patient selection and ensure optimal outcomes.

Keywords

ovarian cancer - fertility preservation - surgical treatment - fertility-sparing surgery - survival


Publication History

Article published online:
28 April 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Sung H, Ferlay J, Siegel RL. et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71 (03) 209-249
    CrossrefPubMedSearch in Google Scholar
  • 2 Querleu D, Planchamp F, Chiva L. et al. European Society of Gynaecological Oncology (ESGO) guidelines for ovarian cancer surgery. Int J Gynecol Cancer 2017; 27 (07) 1534-1542
    PubMedSearch in Google Scholar
  • 3 Zapardiel I, Diestro MD, Aletti G. Conservative treatment of early stage ovarian cancer: oncological and fertility outcomes. Eur J Surg Oncol 2014; 40 (04) 387-393
    PubMedSearch in Google Scholar
  • 4 Berek JS, Renz M, Kehoe S, Kumar L, Friedlander M. Cancer of the ovary, fallopian tube, and peritoneum: 2021 update. Int J Gynaecol Obstet 2021; 155 Suppl 1 (Suppl. 01) 61-85
    CrossrefPubMedSearch in Google Scholar
  • 5 Gorostidi M, Gil-Ibañez B, Alonso S. et al. Fertility preservation treatment of gynecological cancer patients in Spain: a national survey (GOFER study). Arch Gynecol Obstet 2020; 301 (03) 793-800
    PubMedSearch in Google Scholar
  • 6 Rodolakis A, Thomakos N. Fertility preservation for gynecologic cancer patients. In: Ayhan A. ed. ESGO Textbook of Gynecological Oncology. 2021: 1051-1062
    Search in Google Scholar
  • 7 Fruscio R, Corso S, Ceppi L. et al. Conservative management of early-stage epithelial ovarian cancer: results of a large retrospective series. Ann Oncol 2013; 24 (01) 138-144
    PubMedSearch in Google Scholar
  • 8 Heras M, Alonso-Espías M, Arencibia O. et al; YOC-Care Collaborative Group. Real implication of fertility-sparing surgery for ovarian cancer: reproductive outcomes. Diagnostics (Basel) 2024; 14 (13) 1424
    PubMedSearch in Google Scholar
  • 9 Elzakkers JCJ, van der Aa MA, van Altena AM, de Hullu JA, Harmsen MG. Further insights into the role of tumour characteristics in survival of young women with epithelial ovarian cancer. Gynecol Oncol 2019; 155 (02) 213-219
    PubMedSearch in Google Scholar
  • 10 Morice P, Scambia G, Abu-Rustum NR. et al. Fertility-sparing treatment and follow-up in patients with cervical cancer, ovarian cancer, and borderline ovarian tumours: guidelines from ESGO, ESHRE, and ESGE. Lancet Oncol 2024; 25 (11) e602-e610
    CrossrefPubMedSearch in Google Scholar
  • 11 Ray-Coquard I, Morice P, Lorusso D. et al; ESMO Guidelines Committee. Non-epithelial ovarian cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29 (Suppl. 04) iv1-iv18
    PubMedSearch in Google Scholar
  • 12 Kuji S, Harada M, Yoshioka N. et al. Survival and reproductive outcomes after fertility-sparing surgery performed for borderline epithelial ovarian tumor in Japanese adolescents and young adults: results of a retrospective nationwide study. J Obstet Gynaecol Res 2022; 48 (03) 806-816
    PubMedSearch in Google Scholar
  • 13 Falcone F, Malzoni M, Carnelli M. et al. Fertility-sparing treatment for serous borderline ovarian tumors with extra-ovarian invasive implants: analysis from the MITO14 study database. Gynecol Oncol 2022; 165 (02) 302-308
    PubMedSearch in Google Scholar
  • 14 Wang L, Zhong Q, Tang Q, Wang H. Second fertility-sparing surgery and fertility-outcomes in patients with recurrent borderline ovarian tumors. Arch Gynecol Obstet 2022; 306 (04) 1177-1183
    PubMedSearch in Google Scholar
  • 15 Colombo N, Sessa C, du Bois A. et al; ESMO-ESGO Ovarian Cancer Consensus Conference Working Group. ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease. Ann Oncol 2019; 30 (05) 672-705
    PubMedSearch in Google Scholar
  • 16 Bentivegna E, Maulard A, Miailhe G, Gouy S, Morice P. Gynaecologic cancer surgery and preservation of fertility. J Visc Surg 2018; 155 (Suppl. 01) S23-S29
    PubMedSearch in Google Scholar
  • 17 Mangili G, Sigismondi C, Lorusso D. et al. The role of staging and adjuvant chemotherapy in stage I malignant ovarian germ cell tumors (MOGTs): the MITO-9 study. Ann Oncol 2017; 28 (02) 333-338
    PubMedSearch in Google Scholar
  • 18 Low JJ, Perrin LC, Crandon AJ, Hacker NF. Conservative surgery to preserve ovarian function in patients with malignant ovarian germ cell tumors. A review of 74 cases. Cancer 2000; 89 (02) 391-398
    PubMedSearch in Google Scholar
  • 19 Wang D, Cao D, Jia C. et al. Analysis of oncologic and reproductive outcomes after fertility-sparing surgery in apparent stage I adult ovarian granulosa cell tumors. Gynecol Oncol 2018; 151 (02) 275-281
    PubMedSearch in Google Scholar
  • 20 Nasioudis D, Kanninen TT, Holcomb K, Sisti G, Witkin SS. Prevalence of lymph node metastasis and prognostic significance of lymphadenectomy in apparent early-stage malignant ovarian sex cord-stromal tumors. Gynecol Oncol 2017; 145 (02) 243-247
    PubMedSearch in Google Scholar
  • 21 Negri S, Grassi T, Fruscio R. Use of staging for sex cord stromal tumours. Curr Opin Oncol 2022; 34 (05) 504-510
    PubMedSearch in Google Scholar
  • 22 Karalok A, Turan T, Ureyen I. et al. Prognostic factors in adult granulosa cell tumor: a long follow-up at a single center. Int J Gynecol Cancer 2016; 26 (04) 619-625
    PubMedSearch in Google Scholar
  • 23 Wang D, Jia C, Cheng H. et al. Analysis of outcomes and prognostic factors after fertility-sparing surgery in patients with early stage juvenile granulosa cell tumor of the ovary: experience from a tertiary center. J Pediatr Adolesc Gynecol 2022; 35 (04) 486-491
    PubMedSearch in Google Scholar
  • 24 Ikeda Y, Yoshihara M, Yoshikawa N. et al. Is cystectomy an option as conservative surgery for young patients with borderline ovarian tumor? A multi-institutional retrospective study. Int J Gynaecol Obstet 2022; 157 (02) 437-443
    PubMedSearch in Google Scholar
  • 25 Benjamin I, Morgan MA, Rubin SC. Occult bilateral involvement in stage I epithelial ovarian cancer. Gynecol Oncol 1999; 72 (03) 288-291
    PubMedSearch in Google Scholar
  • 26 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Management of adnexal masses. Obstet Gynecol 2007; 110 (01) 201-214
    PubMedSearch in Google Scholar
  • 27 Shiota M, Kotani Y, Umemoto M, Tobiume T, Hoshiai H. Study of the correlation between tumor size and cyst rupture in laparotomy and laparoscopy for benign ovarian tumor: is 10 cm the limit for laparoscopy?. J Obstet Gynaecol Res 2012; 38 (03) 531-534
    PubMedSearch in Google Scholar
  • 28 Zapardiel I, Cruz M, Diestro MD, Requena A, Garcia-Velasco JA. Assisted reproductive techniques after fertility-sparing treatments in gynaecological cancers. Hum Reprod Update 2016; 22 (03) 281-305
    PubMedSearch in Google Scholar
  • 29 Gaughran J, O'Sullivan HR, Lyne T. et al. Fertility-preserving surgery outcomes for ovarian malignancy: data from a tertiary cancer center in Central London. J Clin Med 2022; 11 (11) 3207
    PubMedSearch in Google Scholar
  • 30 Zhang YF, Fan Y, Mu Y, Zhang P, Wang MY, Li JK. Reproductive and oncological outcomes of fertility-sparing surgery in patients with stage I epithelial ovarian cancer: a systematic review and meta-analysis. Medicine (Baltimore) 2022; 101 (31) e29929
    PubMedSearch in Google Scholar
  • 31 Kasaven LS, Chawla M, Jones BP. et al. Fertility sparing surgery and borderline ovarian tumours. Cancers (Basel) 2022; 14 (06) 1-12
    PubMedSearch in Google Scholar
  • 32 Sobiczewski P, Piatek S, Michalski W. et al. Obstetric outcomes after conservative management of ovarian borderline tumors in women of reproductive age: a single center experience. Eur J Obstet Gynecol Reprod Biol 2022; 269: 126-131
    PubMedSearch in Google Scholar
  • 33 Bercow A, Nitecki R, Brady PC, Rauh-Hain JA. Outcomes after fertility-sparing surgery for women with ovarian cancer: a systematic review of the literature. J Minim Invasive Gynecol 2021; 28 (03) 527-536.e1
    PubMedSearch in Google Scholar
  • 34 Xie Q, Meng X, Liao Q. Oncologic outcomes of fertility-sparing surgery in early stage epithelial ovarian cancer: a population-based propensity score-matched analysis. Arch Gynecol Obstet 2022; 306 (05) 1679-1688
    PubMedSearch in Google Scholar
  • 35 Birge Ö, Bakır MS, Doğan S, Tuncer HA, Simsek T. Survival analysis and obstetric outcomes in patients with early stage ovarian cancer undergoing fertility-sparing surgery. J Ovarian Res 2022; 15 (01) 135
    PubMedSearch in Google Scholar
  • 36 Chan JK, Tian C, Monk BJ. et al; Gynecologic Oncology Group. Prognostic factors for high-risk early-stage epithelial ovarian cancer: a Gynecologic Oncology Group study. Cancer 2008; 112 (10) 2202-2210
    PubMedSearch in Google Scholar
  • 37 Cheng X, Cheng B, Wan X, Lu W, Xie X. Outcomes of conservative surgery in early epithelial ovarian carcinoma. Eur J Gynaecol Oncol 2012; 33 (01) 93-95
    PubMedSearch in Google Scholar
  • 38 Kashima K, Yahata T, Fujita K, Tanaka K. Outcomes of fertility-sparing surgery for women of reproductive age with FIGO stage IC epithelial ovarian cancer. Int J Gynaecol Obstet 2013; 121 (01) 53-55
    PubMedSearch in Google Scholar
  • 39 Liu D, Cai J, Gao A, Wang Z, Cai L. Fertility sparing surgery vs radical surgery for epithelial ovarian cancer: a meta-analysis of overall survival and disease-free survival. BMC Cancer 2020; 20 (01) 320
    PubMedSearch in Google Scholar
  • 40 Kajiyama H, Suzuki S, Yoshikawa N. et al. Fertility-sparing surgery and oncologic outcome among patients with early-stage ovarian cancer ∼propensity score- matched analysis∼. BMC Cancer 2019; 19 (01) 1235
    PubMedSearch in Google Scholar
  • 41 Melamed A, Rizzo AE, Nitecki R. et al. All-cause mortality after fertility-sparing surgery for stage i epithelial ovarian cancer. Obstet Gynecol 2017; 130 (01) 71-79
    PubMedSearch in Google Scholar
  • 42 Morrison A, Nasioudis D. Reproductive outcomes following fertility-sparing surgery for malignant ovarian germ cell tumors: a systematic review of the literature. Gynecol Oncol 2020; 158 (02) 476-483
    PubMedSearch in Google Scholar
  • 43 Graham R, MacDonald ND, Lockley M. et al. Surgical management and outcomes for stage 1 malignant ovarian germ cell tumours: a UK multicentre retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2022; 271: 138-144
    PubMedSearch in Google Scholar
  • 44 Park JY, Kim DY, Suh DS. et al. Analysis of outcomes and prognostic factors after fertility-sparing surgery in malignant ovarian germ cell tumors. Gynecol Oncol 2017; 145 (03) 513-518
    PubMedSearch in Google Scholar
  • 45 Sun D, Zhi ZF, Fan JT. Could fertility-sparing surgery be considered for stage I ovarian sex cord-stromal tumors? A comparison of the Fine-Gray model with Cox model. Front Oncol 2022; 12 (September): 964181
    PubMedSearch in Google Scholar
  • 46 Wang D, Jia S, Jia C. et al. Oncological and reproductive outcomes after fertility-sparing surgery in patients with seromucinous borderline ovarian tumor: results of a large retrospective study. Gynecol Oncol 2022; 165 (03) 446-452
    PubMedSearch in Google Scholar
  • 47 Canlorbe G, Chabbert-buffet N, Uzan C. Fertility-Sparing Surgery for Ovarian Cancer. 2021;1–22
    PubMed
  • 48 Li J, Li J, Jiang W. Oncological prognosis and fertility outcomes of different surgical extents for malignant ovarian sex-cord stromal tumors: a narrative review. Cancer Manag Res 2022; 14: 697-717
    PubMedSearch in Google Scholar
  • 49 Brown J, Friedlander M, Backes FJ. et al. Gynecologic Cancer Intergroup (GCIG) consensus review for ovarian germ cell tumors. Int J Gynecol Cancer 2014; 24 (9, Suppl 3): S48-S54
    PubMedSearch in Google Scholar
  • 50 Park JY, Suh DS, Kim JH, Kim YM, Kim YT, Nam JH. Outcomes of fertility-sparing surgery among young women with FIGO stage I clear cell carcinoma of the ovary. Int J Gynaecol Obstet 2016; 134 (01) 49-52
    PubMedSearch in Google Scholar
  • 51 Nam JH, Park JY. Fertility-sparing surgery for young women with early-stage epithelial ovarian cancer. Gynecol Obstet Invest 2013; 76 (01) 14-24
    PubMedSearch in Google Scholar
  • 52 Gracia M, Alonso-Espías M, Zapardiel I. Current limits of conservative treatment in ovarian cancer. Curr Opin Oncol 2023; 35 (05) 389-393
    PubMedSearch in Google Scholar