Outcomes of fertility-sparing surgery in early-stage ovarian cancer; systematic review

Background: Fertility sparing surgery (FSS) is used in women with early-stage ovarian malignancies who aim to preserve fertility, but its oncologic safety still debated. Our review examined oncologic and reproductive outcomes after FSS. Methods: We conduct A PRISMA 2020-based systematic review in PubMed, Web of Science, Scopus, Embase, and the Cochrane Library from inception to early 2024. We include observational and registry-based analyses of reproductive-age women with early-stage epithelial ovarian cancer (EOC), malignant ovarian germ cell tumors (MOGCT), or sex cord-stromal tumors (SCST) treated with FSS. Primary outcomes were OS, disease-free survival, and recurrence; secondary outcomes were pregnancy, menstrual recovery, and live birth. Results: We include 24 studies published between 2002 and 2024, mainly retrospective and included EOC, MOGCT, and SCST. In stage I EOC, large population-based studies showed no significant survival disadvantage with FSS, with 5-year overall survival above 95%. Recurrence after FSS ranged from 2.0% to 27.8%, with higher risk in grade 3 tumors, clear-cell carcinoma, and selected stage IC cases. In women attempting conception, pregnancy rates reached 91.2% in MOGCT and 92.3% in EOC, with live birth rates of 65% to 100% in those who conceived. Conclusion: FSS provide positive oncologic and reproductive outcomes in some women, although epithelial high-risk subgroups and SCST require special counseling and long surveillance.