1. Conservative treatment of recurrent stage I serous borderline ovarian tumors permitted subsequent fertility.
2. Overall survival with conservative treatment was high and most recurrences were non-invasive.
Evidence Rating Level: 4 (Below Average)
Study Rundown: This study found that conservative treatment of recurrent Stage 1 serous borderline ovarian tumors permits subsequent fertility without compromising maternal survival. Findings are clinically relevant, as one-third of patients with these tumors are under age 40. To date only one small study has evaluated conservative management with morbidity, mortality and fertility outcomes. The present work supports existing guidelines that favor a conservative approach to treatment of serous borderline ovarian tumor recurrences.
The present work is limited by small sample size and failure to follow longer-term fertility outcomes. Inconsistent surgical procedures at initial management may also confound results. Future studies might include a large, prospective cohort study that compares conservative treatments and assesses pregnancies delivery and the post-partum period.
Relevant Reading: Borderline tumors of the ovary and fertility
In-Depth [case series]: This study reviewed the outcomes of 26 patients who underwent conservative treatment for their initial stage 1 serous borderline ovarian tumor and first recurrence. Conservative treatment was defined as any surgery preserving the uterus and at least a portion of one ovary. The number of pregnancies and recurrences was the primary outcome.
Among the 16 patients who were fertile and wanted children, 21 pregnancies were achieved in 13 patients, with 17 spontaneous pregnancies. Fifteen of these 21 pregnancies occurred after conservative treatment of the first recurrence. All recurrences were non-invasive disease, but 2 patients had invasive disease at the second or third recurrence, and one patient passed away after the third recurrence.
By Denise Pong, MPH and Leah Hawkins, MD, MPH
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