Incidence of Ovarian Metastases in Reproductive-Aged Women with Appendiceal Cancer: Implications for Fertility Preservation

PURPOSE: Incidence of appendiceal cancer is increasing, with one-third of patients diagnosed before age 50 years. Fertility preservation (FP) is important for patients who have not completed childbearing; however, the safety of oocyte and embryo banking remains unclear due to concerns for ovarian metastases. This study evaluates incidence of ovarian metastases at cytoreductive surgery (CRS) and describes FP practices and outcomes among reproductive-aged women with appendiceal cancer. METHODS: A retrospective review was conducted of female patients aged 18-45 years treated for appendiceal cancer at MD Anderson Cancer Center from January 2020 to January 2025. Clinical, surgical, pathologic, and fertility-related variables were collected. Descriptive statistics assessed rates and laterality of ovarian metastases, FP practices, and reproductive outcomes. RESULTS: A total of 100 reproductive-aged women (median age 35.9 years, range 19-44 years) with histology-confirmed appendiceal cancer were identified, of whom 47 underwent CRS. Ovarian metastases were documented in 89.4% (42/47), with bilateral involvement in 71.4% (30/42) and unilateral involvement in 28.6% (12/42). Fertility-sparing surgery included retention of one ovary in 25.5% (12/47) and uterine preservation in 19.1% (9/47). Among patients retaining an ovary, 60% developed amenorrhea after adjuvant therapy. Desire for FP was documented in 23.4% (11/47), all were referred for oncofertility consultation. Five patients underwent oocyte or embryo cryopreservation before CRS, including three with confirmed ovarian involvement. CONCLUSION: Reproductive-aged women with appendiceal cancer have a high and often bilateral incidence of ovarian metastases, with important implications for FP safety. Individualized fertility counseling prior to CRS is essential to optimize reproductive outcomes while maintaining oncologic safety.