Malignant Ovarian Neoplasms The Place of Conservative Surgery

Even though radical surgery is the treatment of choice in malignant neoplasms, a conservative approach may be considered in young patients who wish to preserve fertility, provided well-defined criteria are met and survival is not jeopardized. Unilateral, stage I, borderline (BT), germ cell (OGCT), sex cord stromal tumors, and grade I epithelial cancer can be treated with unilateral salpingoophorectomy (USO). If bilateral ovarian involvement is present, bilateral salpingoophorectomy (BSO) and preservation of the uterus can be considered. Cystectomy is rarely practiced, because of published contraindications, in borderline tumors. Complete surgical staging is mandatory in all cases regardless of the type of surgery (USO or BSO). Conservative management of more advanced disease is considered in a few BT and OGCT cases, provided it can be combined with successful cytoreduction. Adjuvant chemotherapy is necessary in almost all OGCT and epithelial cancers, although its role in BT and sex cord tumors is unspecified yet. Current knowledge suggests that conception is possible after conservative management for malignant ovarian neoplasms and chemotherapy does not cause obvious genetic malformations in the newborn.