The demand for fertility-sparing surgery (FSS) has increased in the last decade due to increased maternal age, increased incidence of ovarian malignancies in younger patients, and technical advances in surgery. Data on oncological safety and fertility outcomes of patients with ovarian cancer after laparoscopic FSS are sparse, but some retrospective studies have shown that open FSS may be offered to selected patients. We assessed the role of minimally invasive FSS in comparison with radical surgery (RS) in terms of oncological safety and reproductive outcomes after FSS in this multicenter study. Eighty patients with FIGO stage I/II ovarian cancer treated with laparoscopic FSS or RS between 01/2000 and 10/2018 at the participating centers (comprehensive gynecological cancer centers with minimally invasive surgical expertise) were included in this retrospective analysis of prospectively kept data. Case–control (n= 40 each) matching according to the FIGO stage was performed. Progression-free survival [150 (3–150) and 150 (5–150) months;p= 0.61] and overall survival [36 (3–150) and 50 (1–275) months;p= 0.65] did not differ between the FSS and RS groups. Eight (25.8%) women became pregnant after FSS, resulting in seven (22.5%) deliveries; three (37.5%) patients conceived after in vitro fertilization, and five (62.5%) conceived spontaneously. Laparoscopic FSS seems to be applicable and oncologically safe for patients with early-stage ovarian cancer, with adequate fertility outcomes.
过去十年间，由于产妇年龄增长、年轻患者卵巢恶性肿瘤发病率上升以及手术技术进步，保留生育功能手术的需求日益增加。目前关于卵巢癌患者接受腹腔镜保留生育功能手术后肿瘤安全性和生育结局的数据较为有限，但部分回顾性研究表明开放式保留生育功能手术可适用于特定患者群体。本多中心研究旨在评估微创保留生育功能手术与根治性手术在肿瘤安全性和生育结局方面的比较价值。本研究对前瞻性收集的数据进行回顾性分析，纳入了2000年1月至2018年10月期间在参与中心（具备微创手术专业能力的综合性妇科肿瘤中心）接受腹腔镜保留生育功能手术或根治性治疗的80例FIGO I/II期卵巢癌患者。研究采用病例对照匹配设计（每组40例），根据FIGO分期进行配对。结果显示：保留生育功能手术组与根治性手术组在无进展生存期[150（3-150）个月 vs 150（5-150）个月；p=0.61]和总生存期[36（3-150）个月 vs 50（1-275）个月；p=0.65]方面均无统计学差异。保留生育功能手术后，8例（25.8%）患者成功妊娠，其中7例（22.5%）实现分娩；3例（37.5%）通过体外受精受孕，5例（62.5%）为自然受孕。研究表明，腹腔镜保留生育功能手术对早期卵巢癌患者具有可行性，在肿瘤安全性方面表现良好，并能获得理想的生育结局。
Laparoscopic Fertility-Sparing Surgery for Early Ovarian Malignancies
肿瘤(癌症)患者之家