Clinical outcomes and fertility after conservative treatment of ovarian borderline tumors

Objective: To assess clinical outcome and fertility in patients treated conservatively for a low malignant potential (LMP) ovarian tumor. Design: Retrospective study. Setting: Gynecologic oncology department of a cancer care center in France. Patient(s): Forty-four patients treated with conservative management for a stage I (n = 32) or stage II or III (n = 12) LMP tumor. Intervention(s): Thirty-three patients had unilateral adnexectomy and 11 had cystectomy. Cystectomy was bilateral in 1 patient and was done in conjunction with contralateral adnexectomy in 5 patients. Main Outcome Measure(s): Tumor recurrence and pregnancy rates. Result(s): Tumor recurrence rates after radical surgery (hysterectomy with bilateral salpingo-oophorectomy), adnexectomy, and cystectomy were 5.7%, 15.1%, and 36.3%, respectively (P<.01). Among patients who initially received conservative treatment, tumors did not recur in the form of invasive carcinoma. Five patients who had recurrence underwent repeated conservative management; these patients are alive and free of disease. Seventeen pregnancies (of which 15 were spontaneous) occurred in 14 patients; 13 pregnancies occurred in patients with stage I disease and 4 occurred in patients with stage III disease. Conclusion(s): Conservative management of LMP tumor significantly increases the risk of recurrence but does not affect overall survival. Such management offers even patients with advanced disease the chance to have spontaneous pregnancy. Conservative management might be proposed in young patients who wish to preserve their fertility, but careful follow-up will be required to detect tumor recurrence.