If possible, an extrafascial total abdominal hysterectomy and bilateral salpingo-oophorectomy should be performed. However, in young patients who desire to preserve fertility, several studies support conservative surgical staging when the disease is confined to one ovary. Schilder and collegues64 in a multi-institutional retrospective investigation examined 52 women presenting with stage IA and IC epithelial ovarian carcinoma who were treated with fertility-sparing surgery. Five patients developed tumor recurrence 8 to 78 months after initial surgery, and two died of recurrent cancer. Of the five recurrences, three occurred in the contralateral ovary. Twenty-four patients attempted pregnancy and 17 (71%) conceived. These 17 patients had 26 full-term deliveries. Likewise in their retrospective analysis of 56 patients treated with fertility-sparing surgery and 43 treated with the removal of the internal genital apparatus, Zanetta and associates65 reported a 9% recurrence rate in the group treated conservatively compared with 12% in those treated with conventional surgery after a median follow-up of 7 years. Benjamin and associates66 identified 118 women who had undergone a full-staging laparotomy including bilateral salpingo-oophorectomy for stage I disease. In 3 out of 118 (2.5%) patients, the contralateral ovary was found to have histologic evidence of malignancy despite looking normal at the time of laparotomy. Because of their low yield, potential deleterious effects on ovarian reserve, and risk of postoperative adhesions, which can impair fertility, biopsies of the apparently normal contralateral ovary should be abandoned. Finally, because of the possibility of endometrial involvement by the disease, an endometrial biopsy may be indicated when performing a conservative procedure for early ovarian cancer. Some clinicians have also advocated for a systematic appendectomy owing to the presence of microscopic metastasis in up to 37% of patients and the possibility of an occult appendiceal primary in the presence of a mucinous tumor.67
Was this article helpful?
Far too many people struggle to fall pregnant and conceive a child naturally. This book looks at the reasons for infertility and how using a natural, holistic approach can greatly improve your chances of conceiving a child of your own without surgery and without drugs!