Volume 8, Issue 2, April 2020, Page: 71-75
Ovarian Conservation in Patients with Early Stage Endometrial Carcinoma (EC) as a Safe Alternative to Oophorectomy
Walid A. Abdelsalam, Department of Gynecology and Obstetrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Mohamed Fathy Abohashim, Department of Gynecology and Obstetrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Doaa Mandour, Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Taha A. Baiomy, Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Ibrahim Heggy, Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Received: Feb. 25, 2020;       Accepted: Mar. 6, 2020;       Published: Apr. 17, 2020
DOI: 10.11648/j.js.20200802.16      View  90      Downloads  48
Abstract
Background: Premenopausal females having early-stage EC have a favorable prognosis. The guidelines of surgical treatment of EC have not been modified and it consists of total hysterectomy, bilateral salpingo-oophrectomy, pelvic and para-aortic lymphadenectomy, regardless of patients’ age or EC stage. The drawbacks of performing bilateral BSO are induction of surgical premature menopause which subsequently disturbs physical and psychosexual life in addition to increasing risk of diseases of the cardiovascular system and bone fractures. The aim of our study was to demonstrate if performing BSO in premenopausal females patients with early stage EC had survival benefits and improving long-term outcomes or not. Patients and methods; we included sixty EC patients and we have performed ovarian conservation in 30 (50%) of them, and performed BSO in the remaining 30 patients we have followed our patients for 5 years from December 2014 to December 2019. Results: Age of patients with ovarian conservation was younger than patients with BSO (p=0.032), have smaller tumor size (p=0.02), higher degree of tumor differentiation (p=0.025), less incidence of myomertrial invasion (p=0.004), less liability of lymphovascular invasion (p=0.001), more liability to endometrioid histopathological subtype (p=0.003), and earlier stage (p=0.009) than patients with BSO. There were no significant differences between both studied groups regarding recurrence of the tumor, recurrence free survival and overall survival rates. Conclusion: The current study tried to highlight the benefits of a more conservative approach by ovarian preservation in surgical management and staging of EC patients diagnosed in the early stage in young premenopausal women.
Keywords
Endometrial Cancer, Conservation of Ovaries, Survival
To cite this article
Walid A. Abdelsalam, Mohamed Fathy Abohashim, Doaa Mandour, Taha A. Baiomy, Ibrahim Heggy, Ovarian Conservation in Patients with Early Stage Endometrial Carcinoma (EC) as a Safe Alternative to Oophorectomy, Journal of Surgery. Vol. 8, No. 2, 2020, pp. 71-75. doi: 10.11648/j.js.20200802.16
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Jia P and Zhang Y. Ovarian preservation improves overall survival in young patients with early-stage endometrial cancer Oncotarget, 2017, Vol. 8, (No. 35), pp: 59940-59949.
[2]
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clinic. (2019) 69 (Suppl. 12): 7–34.
[3]
Lau HY, Chen MY, Ke YM, et al. Outcome of ovarian preservation during surgical treatment for endometrial cancer: a Taiwanese Gynecologic Oncology Group study. Taiwan J Obstet Gynecol 2015; 54: 532–536.
[4]
Lee TS, Kim JW, Kim TJ, Cho CH, Ryu SY, Ryu HS, et al. Ovarian preservation during the surgical treatment of early stage endometrial cancer: a nationwide study conducted by the Korean Gynecologic Oncology Group. Gynecol Oncol 2009; 115: 26-31.
[5]
Lyu T, Guo L, Chen X, Jia N, Gu CH, Zhu M et al. Ovarian preservation for premenopausal women with early-stage endometrial cancer: a Chinese retrospective study Journal of International Medical Research 2019; 47 (6) 2492–2498.
[6]
Lin KY, Miller DS, Bailey AA, et al. Ovarian involvement in endometrioid adenocarcinoma of uterus. Obstet Gynecol 2015; 138: 532–535.
[7]
Pan Z, Wang X, Zhang X, et al. Retrospective analysis on coexisting ovarian cancer in 976 patients with clinical stage I endometrial carcinoma. J Obstet Gynaecol Res 2011; 37: 352–358.
[8]
Walsh C, Holschneider C, Hoang Y, Tieu K, Karlan B, Cass I. Coexisting ovarian malignancy in young women with endometrial cancer. Obstet Gynecol 2005; 106: 693-9.
[9]
Barakat RR, Bundy BN, Spirtos NM, Bell J, Mannel RS. Randomized doubleblind trial of estrogen replacement therapy versus placebo in stage I or II endometrial cancer: a Gynecologic Oncology Group Study. J Clin Oncol 2006; 24: 587-92.
[10]
Li J, Zhu Q, Yang B, et al. Risk factors for ovarian involvement in young and premenopausal endometrioid endometrial cancer patients. Eur J Obstet Gynecol Reprod Biol 2018; 222: 151–154.
[11]
Hou T, Sun Y, Li J, et al. The safety of ovarian preservation in stage i endometrial endometrioid adenocarcinoma based on propensity score matching. Comb Chem High Throughput Screen 2017; 20: 647–655.
[12]
Matsuo K, Machida H, Shoupe D, et al. Ovarian conservation and overall survival in young women with early-stage cervical cancer. Obstet Gynecol 2017; 129: 139–151.
[13]
Wright JD, Jorge S, Tergas AI, et al. Utilization and outcomes of ovarian conservation in premenopausal women with endometrial cancer. Obstet Gynecol 2016; 127: 101–108.
[14]
Gonthier C, Trefoux-Bourdet A and Koskas M. Impact of conservative managements in young women with grade 2 or 3 endometrial adenocarcinoma confined to the endometrium. Int J Gynecol Cancer 2017; 27: 493–499.
[15]
Gu H, Li J, Gu Y, et al. Survival impact of ovarian preservation on women with earlystage endometrial cancer: a systematic review and meta-analysis. Int J Gynecol Cancer 2017; 27: 77–84.
Browse journals by subject