Fertility-sparing surgery in high-risk epithelial ovarian cancer: from the patients wishes to the precautionary principle
Fertility preservation is an important consideration for women with gynecologic malignancies, given the potentially severe psychological impact of infertility. Fertility-sparing surgery (FSS) of epithelial ovarian cancer (EOC) is an empirical treatment option initially proposed to young women presenting with an early-stage invasive tumor and a low risk of recurrence [1,2]. It is based on unilateral (salpingo-)oophorectomy and complete surgical staging and seems to be oncologically safe in patients with conventional histologic subtype and stage IA grade 1 or 2 disease . The recurrence rates reported in these subgroups were 7% in stage IA grade 1 and 11% in stages IA grade 2, so very close, or similar, to the rates observed after radical surgery [2-6]. Despite the importance of considering FSS for patients, however, many questions remain concerning its safety in stage I “high risk” patients (grade 3 and/or stage IC and/or clear cell tumor).