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19-12-2017 | Ovarian cancer | Editorial | Article

Fertility-sparing surgery in high-risk epithelial ovarian cancer: from the patients wishes to the precautionary principle

Philippe Morice MD, PhD, Sébastien Gouy MD, PhD
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 [2]. 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). 

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