Fertility-sparing surgery for ovarian low malignant potential tumors Gautam G. Rao a , Elizabeth N. Skinner b , Paola A. Gehrig b , Linda R. Duska c , David S. Miller a , John O. Schorge a, * a Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, J7.124, Dallas, TX 75390-9032, USA b University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA c Harvard Medical School-Massachusetts General Hospital, Boston, MA 02115, USA Received 12 January 2005 Available online 16 June 2005 Abstract Objective. Ovarian low malignant potential (LMP) tumors have an excellent prognosis when treated by surgical resection. Conservative management usually involves leaving behind the uterus and contralateral adnexa to allow future childbearing. The purpose of this study was to determine the outcome of women treated with fertility-sparing surgery. Methods. All patients diagnosed with ovarian LMP tumors between 1984 and 2003 were identified at three institutions. Data were retrospectively extracted from clinical records. Results. Thirty-eight (15%) of 249 women with LMP tumors underwent fertility-sparing surgery. Twenty-three were nulliparous and four primiparous. Thirty-three (87%) underwent unilateral salpingo-ophorectomy and five (13%) cystectomy. Fourteen patients also had contralateral cystectomy or biopsy. Thirty-four (89%) were stage I, one (3%) stage II and three (8%) stage III. Most tumors had serous (55%) or mucinous (42%) histology. No patients received adjuvant therapy. Six (16%) of 38 recurred after a median follow-up of 26 months: five in the remaining ovary were salvaged with surgical resection alone, and none died from recurrent LMP tumor. Five women delivered six term infants during post-treatment surveillance. Conclusion. Fertility-sparing surgery for ovarian LMP tumors is an option for motivated patients. Preservation of the contralateral adnexa increases the risk of recurrence, but surgical resection is usually curative. D 2005 Elsevier Inc. All rights reserved. Keywords: Fertility-sparing surgery; Ovarian borderline tumor Introduction Low malignant potential (LMP) tumors account for approximately 15% of all epithelial ovarian cancers [1]. These neoplasms have histologic and biologic features that are intermediate to those of clearly benign and frankly malignant ovarian tumors. Criteria for making the diagnosis include the presence of nuclear atypia, stratification of the epithelium, formation of microscopic papillary projections and minimal or absent stromal invasion. Patients with ovarian LMP tumors have a 10-year survival rate of 95% [2]. Complete resection by hysterectomy and bilateral salpingo-oophorectomy is the standard treatment. Fertility-sparing surgery may be an option for selected patients [3–8]. Leaving behind the uterus and contralateral adnexa increases the risk of disease recurrence due to the possibility of bilateral synchronous tumors or occult metastases [4,5,8]. Since the majority of women are diagnosed with ovarian LMP tumors during their repro- ductive years, many are willing to accept additional risk to maintain their fertility. Trimble et al. observed that half of women less than 40 years of age underwent fertility- sparing surgery [2]. The risk of a new primary lesion/ recurrence after conservative management ranges from 0– 19% [3–8]. Presumably, complete resection would have prevented most of these events. 0090-8258/$ - see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.ygyno.2005.04.025 * Corresponding author. Fax: +1 214 648 8404. E-mail address: john.schorge@utsouthwestern.edu (J.O. Schorge). Gynecologic Oncology 98 (2005) 263 – 266 www.elsevier.com/locate/ygyno