Fertility results after conservative treatment of advanced stage serous borderline tumour of the ovary Sophie Camatte, Philippe Morice * , Patricia Pautier, David Atallah, Pierre Duvillard, Damienne Castaigne Objective To assess the fertility of patients treated conservatively for a Stage II or III borderline ovarian tumour. Design A retrospective study. Setting Gynaecological oncology department in a French anti-cancer centre. Population Seventeen patients treated with conservative management for a Stage II (n ¼ 6) or III (n ¼ 11) borderline ovarian tumour were followed up. Fifteen patients underwent a unilateral salpingo-oophorectomy (with contralateral cystectomy in six patients), one had unilateral cystectomy and one a bilateral cystectomy. Fourteen patients had non-invasive implants and three had invasive implants. Main outcome measures Pregnancy rates and outcome. Results Eight pregnancies were observed in seven patients in a median delay of eight months following the surgical procedure. Six pregnancies were observed spontaneously, one occurred after an ovarian stimulation and one after an IVF procedure. None of these patients recurred under the form of invasive ovarian carcinoma on the spared ovary. Two patients (one with a non-invasive disease and one with an invasive one) had recurrence in the form of evolutive invasive implants, but neither woman died. Conclusion Spontaneous pregnancy can occur after conservative treatment of advanced stage borderline tumour of the ovary (with non-invasive implants). Such management, performed in a close follow up of the patients, does not affect the overall survival. Conservative surgery could be proposed in patients with borderline tumour of the ovary and non-invasive peritoneal implants. INTRODUCTION A recent series of studies suggest that conservative surgery could be appropriate for women with invasive epithelial ovarian tumour 1–3 , but the prognosis for those with advanced stage disease (with peritoneal implants) remains unclear 3 . In patients with borderline ovarian tumour, however, conservative treatment can be safely proposed at early stage of disease 4–6 . Very few studies have reported the fertility outcome of conservative man- agement in patients with advanced stage serous borderline tumour of the ovary. In this study we report a series of 17 women treated conservatively for Stage II or III borderline tumour, focusing on the assessment of fertility results. METHODS From January 1969 to July 2000, seventeen patients with serous borderline tumour and peritoneal implants were treated conservatively at the Gustave-Roussy Institute. Conservative treatment was defined as a surgical procedure with conservation of the uterus and at least a portion of one ovary. Histopathologic review of the ovarian tumour and peritoneal implants was performed by the same pathologist ( P.D.). The 1987 FIGO staging classification was used 7 . The stage of disease was assigned by using the mac- roscopic description during the surgical procedure, and by reviewing the pathology records. Stages II and III are defined by the presence of an ovarian borderline tumour in addition to pelvic (Stage II ) and /or abdominal (Stage III ) peritoneal implants. Peritoneal implants were classified as non-invasive or invasive, according to the absence or presence of stromal invasion of the peritoneum 8 . During conservative surgery of the ovary, additional surgical procedures were occasionally performed: biopsy of contralateral ovary, omentectomy, multiple peritoneal biopsies and pelvic and /or para-aortic lymphadenectomy. Performance of these procedures depended on knowing the date at which this treatment was given, the teams who surgically treated those patients and the confirmation of the diagnosis of LMP tumour, during or after the surgical procedure. In some patients, adjuvant treatment could be proposed (e.g. chemotherapy, external radiation therapy, and chemo- therapy with external radiation therapy). The type of BJOG: an International Journal of Obstetrics and Gynaecology April 2002, Vol. 109, pp. 376–380 D RCOG 2002 BJOG: an International Journal of Obstetrics and Gynaecology PII:S1470-0328(02)01359-9 www.bjog-elsevier.com Gustave-Roussy Institute, Villejuif, France * Correspondence: Dr P. Morice, Service de Chirurgie Gyne ´cologique, Institut Gustave-Roussy, 39 rue Camille-Desmoulins, 94805 Villejuif Cedex, France.