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The presenter has no conflict of interest to declare .

Fertility-sparing surgery in borderline and non epithelial ovarian tumors: State of the Art. ESGO 2013 Liverpool. Giorgia Mangili MD Cristina Sigismondi MD IRCCS Ospedale San Raffaele, Milan Gynecology Oncology Department Prof. M.Candiani.

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  1. Fertility-sparing surgery in borderline and non epithelial ovarian tumors: State of the Art ESGO 2013 Liverpool Giorgia Mangili MDCristina Sigismondi MDIRCCS Ospedale San Raffaele, MilanGynecologyOncologyDepartmentProf. M.Candiani The presenter has no conflict of interest to declare.

  2. Borderline Ovarian Tumors (BOT)

  3. Borderline Ovarian Tumors: Early Stage UnilateralSalpingo-oophorectomy + peritonealstaging 0-5% RadicalSurgery 0-25% Unilateralsalpingo-oophorectomy 10-42% Cystectomy Daraï et al. HumReprod Update. 2013 DuBoiset al. Eur J Cancer. 2013 • Fertility-sparing treatment: INDIPENDENT PROGNOSTIC FACTOR FOR RECURRENCE • Rate of recurrence NO IMPACT ON SURVIVAL • Risk of lethal recurrence < 0.05%

  4. Serous Borderline Ovarian Tumors

  5. Bilaterality in Borderline Ovarian tumors BILATERAL CYSTECTOMY (experimentalgroup, n = 15) versus SALPINGO-OOPHORECTOMY AND CYSTECTOMY (control group, n = 17) • No difference in cumulative recurrence rate • Shortertimeto first recurrence and higher rate ofradical treatment • Betterreproductiveoutcomes Human Reproduction. 2010

  6. 26 patients • Allpatientshad a borderline histology at first recurrence • 11 patientsrelapsed at leasttwice • 2 patientshadan invasive histology at 2-3 recurrence (1 DOD) “Fertility-preserving surgery remains a valuable alternative in young patients with recurrent BOT, in the form of a non-invasive ovarian lesion, who wish to start a pregnancy.” Human Reproduction. September 25, 2013

  7. Advanced Stages BOTFertility-sparing Treatment

  8. Stromal Ovarian Tumors

  9. Granulosa cell tumors

  10. Fertility-sparing Surgery in Granulosa Cell Tumors Conservative surgery can beofferedto young women whodesiretoretainfertility Colombo et al. J ClinOncol. 2007 Thrallet al. GynecolOncol. 2012 • Unilateralsalpingo-oophorectomy • Peritonealstaging • Endometrialbiopsy • NO contralateralbiopsy • NO lymphadenectomy

  11. Sertoli-Leydig Cell Tumors No difference in survival rate between conservative and radicalsurgery

  12. Malignant germ cell ovarian tumors (MOGCT)

  13. Fertility-sparing Surgery in MOGCT CONSERVATIVE SURGERY + PEB Exceptfor Stage IA dysgerminoma and stage I immature teratoma

  14. Bilateral MOGCT • Bilaterality 4.3% (dysgerminoma 15%) • USO+CYS+staging If CYS isnotpossible? Residual disease could be intentionally left in order to spare fertility 3 patients reported (2 OSR, 1 Vicus et al Gyn Onc 2010) • XY disgeneticgonads bilateralgonadectomy, spare the uterus! • 2 patientsconceivedthrough IVF withdonoroocyte • Mangiliet al. GynecolOncol. 2011

  15. Fertility Outcome in MOGCT • Small number of patients • Short follow-up • Young patients Premature ovarianfailure 3%

  16. Reproductive function assessment after surgery plus chemotherapy for Germ Cell Ovarian Tumors: novel clues deriving from the field of fertility preservation Oocytescryopreservation Ottolina et al. Submitted

  17. The Fertility WindowEvaluation of ovarian reserve Spontaneousconception/ ART Ovarianreserve YES AMH DESIRE FOR PREGNANCY NO La Marca et al. Eur J Obstet Gynecol Reprod Biol. 2012 Preservationoffertility

  18. Conclusions Fertility-sparingsurgery in borderline ovariantumors and non epithelialovariancancersisfeasible The fertilitywindowmaybeshortenedbyoncologicaltreatments Reproductivefunction&Oncological follow-up isrequired

  19. Thank you! ginecologia.oncologica@hsr.itmangili.giorgia@hsr.it

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