Fertility-sparing surgery can effectively treat borderline ovarian tumors (BOTs), while preserving a woman’s ability to conceive and bear children, a new study suggests.
The study, “Reproductive and obstetrical outcomes with the overall survival of fertile-age women treated with fertility-sparing surgery for borderline ovarian tumors in Sweden: a prospective nationwide population-based study,” was published in Fertility and Sterility.
BOTs make up about 10%–20% of all ovarian cancers, and about a third of them occur in women of childbearing age. These cancers tend to be diagnosed relatively early, and can often be treated surgically.
Two surgeries can be used to treat BOTs. First is radical surgery, in which the ovaries and uterus are removed entirely. Second is fertility-sparing surgery, which aims to preserve the uterus and at least part of the ovaries.
While radical surgery can effectively treat cancer, it has the obvious side effect of removing the patient’s ability to become pregnant and bear children, since the reproductive organs required to do so are removed.
As its name suggests, the goal of fertility-sparing surgery is to remove the cancer, while preserving the patient’s reproductive ability. Previous studies have suggested that, even though fertility-sparing treatment may have higher cancer recurrence rates, both types of surgeries are comparable in terms of their effect on cancer-related outcomes like survival.
However, little scientific research has directly assessed whether patients who undergo fertility-sparing surgery are able to become pregnant and bear children afterwards.
“In the choice of treatment for borderline ovarian tumours, safety and the effectiveness for future childbearing must be taken into account,” Kenny Rodriguez-Wallberg, study co-author and researcher at Karolinska Institute, said in a press release.
In the new study, researchers at Karolinska and other universities in Sweden analyzed data from national databases, and identified females, 18 to 40 years of age, who underwent surgery for BOT from 2008 to 2015. Of the 277 identified, 213 (77%) underwent fertility-sparing surgery. The remainder underwent radical surgery.
Individuals who underwent fertility-sparing surgery were significantly younger, on average, than those who underwent radical surgery (30 vs. 36 years).
Of the 213 who underwent fertility-sparing surgery, 50 (23%) got pregnant and gave birth at some point after surgery. The average length of time between surgery and birth was 32 months, and the average age of the women who gave birth was 30.
Of note, the follow-up time was significantly shorter for females who did not become pregnant following fertility-sparing surgery than for those who had conceived.
Several women had multiple pregnancies. In total, 50 women gave birth to 62 children, including one set of twins. Most (69%) of the babies were delivered vaginally. Five babies (8%) were preterm, though all of them were born in the third trimester.
Of the 213 women who underwent fertility-sparing surgery, 20 (9%) used assistive reproductive technologies (i.e., in vitro fertilization) after surgery. Of these 20, eight became pregnant and gave birth, which is a fairly typical birthrate for these types of technologies.
“The ability to become pregnant seems to be preserved with fertility-sparing surgery,” Gry Johansen, study co-author and doctoral student at Karolinska Institutet.
The researchers noted that, since the national databases don’t record whether women were attempting to conceive children, it’s impossible to calculate an exact pregnancy rate. But the results, nonetheless, show that it is possible, even common, to become pregnant after fertility-sparing surgery.
The overall survival rate five years after surgery was high for both fertility-sparing surgery (98%) and radical surgery (100%). Of the four deaths recorded during the studied time period, three were attributed to BOTs and happened in individuals who underwent surgery and then had their cancer return. One of them gave birth shortly before the recurrence.
“The [overall survival] rate for our cohort with BOTs was not impaired by FSS compared with [radical surgery], mirroring previous reports,” the researchers wrote. “Patients should receive complete information concerning their prognosis and risks after recommended treatment, especially if a conservative treatment such as FSS is given. Therefore, studies like ours are important and needed.”
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