Fertility preservation in women with ovarian malignancy discovered at laparoscopy

Objective. To assess the efficacy of deferred surgery on fertility preservation in women with early ovarian malignancy discovered at laparoscopy. Methods. Over a 3-year period, patients who had laparoscopic surgery for ovarian cysts underwent a defined protocol that included preoperative malignancy assessment, non-spillage laparoscopic technique and frozen-section histological determination. In a retrospective analysis, four cases of ovarian malignancy were found in reproductive age patients. Their staging laparotomy was deferred until after the final histological results were obtained. The avoidance of extensive surgery and achievement of pregnancy was considered to be a successful outcome. Results. Deferring the staging laparotomy until after the final histological results informed us of the grading of the tumour and allowed us to avoid hysterectomy or removal of the contralateral ovary in cases of stage I, grade I tumours. Only one patient underwent hysterectomy. Two patients had wedge resection from the contralateral ovary, and one had bilateral ovariectomy. The latter three have already achieved pregnancy, including the patient with bilateral ovariectomy who had a successful IVF treatment with donor ova. Conclusion. In cases of ovarian malignancy discovered at laparoscopy, deferring the staging laparotomy till after the final histological results may give the opportunity of preserving fertility as well as that of scheduling a gynaecological oncologist for the operation.