Fertility Sparing Surgery Upon Reproductive and Oncologic results in Ovarian Cancer patients Stage I (FIGO): A Systematic Review

Fertility Sparing Surgery Upon Reproductive and Oncologic results in Ovarian Cancer patients Stage I (FIGO): A Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Fertility Sparing Surgery Upon Reproductive and Oncologic results in Ovarian Cancer patients Stage I (FIGO): A Systematic Review Stylianos Sergios Chatziioannou, Chrisostomos Sofoudis This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6115489/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose This systematic review evaluates the oncologic and reproductive outcomes of fertility-sparing surgery (FSS) in women diagnosed with stage I ovarian cancer, as classified by the International Federation of Gynecology and Obstetrics (FIGO). The goal is to assess the safety and effectiveness of FSS in preserving fertility without compromising survival outcomes. Methods A systematic search was conducted in MEDLINE (PubMed), SCOPUS, and Google Scholar for studies published in English from 2014 onward. Studies involving women under 50 with stage I ovarian cancer who opted for FSS were included. Data extraction focused on oncologic outcomes (recurrence and survival rates) and reproductive outcomes (pregnancy and live birth rates). Study selection followed PRISMA guidelines. Results Seventeen studies comprising 1030 patients met the inclusion criteria. Pregnancy success rates ranged from 25–91.3%, with live birth rates exceeding 80% in most studies. Spontaneous conception was predominant, though 3.7–28% of patients required assisted reproductive technologies (ART). Despite 58% of patients expressing a desire for future pregnancy, only 13% actively attempted conception. Recurrence rates varied from 3–33.3%, with most studies reporting between 8% and 15%. Overall survival ranged from 88–100%, and disease-free survival remained above 90%. The highest recurrence was observed in mucinous ovarian carcinoma and FIGO Stage IC2/IC3 subtypes. Conclusion FSS in stage I ovarian cancer is a viable alternative to radical surgery in carefully selected patients, with favorable oncologic and reproductive outcomes. However, recurrence risks and fertility challenges highlight the need for multidisciplinary counseling, long-term surveillance, and further research to refine selection criteria and optimize fertility preservation techniques. Obstetrics & Gynecology Fertility preservation fertility-sparing surgery ovarian cancer reproductive outcomes survival rates Figures Figure 1 Introduction Fertility-sparing surgery (FSS) in the context of early-stage ovarian cancer, specifically Stage I as classified by the FIGO, represents a critical intersection of oncological treatment and reproductive health[ 1 ]. The diagnosis of ovarian cancer, particularly in younger women, poses significant challenges not only in terms of survival but also regarding the preservation of fertility[ 2 ]. As the incidence of ovarian cancer in women of reproductive age continues to be a pressing concern, the exploration of FSS as a viable treatment option has garnered increasing attention within the medical community[ 3 ]. This systematic review aims to synthesize the existing literature on FSS for Stage I ovarian cancer, evaluating both oncological outcomes and reproductive implications, thereby providing a comprehensive overview for clinicians and patients alike. The significance of FSS arises from the unique demographic of women affected by ovarian cancer. Approximately 10% of ovarian cancer cases occur in women under the age of 40, a population that often prioritizes the preservation of reproductive potential alongside effective cancer treatment[ 4 ]. Traditional treatment paradigms for ovarian cancer have typically involved radical surgical approaches, including total abdominal hysterectomy and bilateral salpingo-oophorectomy, which inherently compromise fertility[ 5 , 6 ]. However, the evolving understanding of the biology of early-stage ovarian cancer, particularly low-grade tumors and certain histological subtypes, has led to a revaluation of treatment strategies that prioritize both oncological safety and reproductive desires[ 1 , 3 ]. The current clinical guidelines from organizations such as the American College of Obstetricians and Gynaecologists (ACOG) and the European Society for Medical Oncology (ESMO) endorse FSS for select patients with Stage I ovarian cancer, particularly those with favourable tumor characteristics[ 7 – 9 ]. These guidelines reflect a growing consensus that, in appropriately selected cases, FSS can achieve comparable oncological outcomes to radical surgery while allowing for the preservation of the uterus and at least one ovary. The oncological safety of FSS has been supported by numerous studies indicating that women undergoing FSS for Stage I ovarian cancer experience similar rates of overall survival and disease-free survival compared to those undergoing more radical interventions[ 10 , 11 ]. Two meta-analysis conducted highlighted that FSS does not significantly compromise survival outcomes in women with early-stage epithelial ovarian cancer, suggesting that the oncological risks associated with this approach may be minimal when performed in a controlled setting[ 12 , 13 ]. Furthermore, specific histological subtypes, such as mucinous and endometrioid ovarian cancers, have shown favourable outcomes with FSS, reinforcing the notion that individualized treatment plans based on tumor biology can enhance both survival and reproductive prospects[ 14 ]. The ability to perform FSS safely hinges on careful patient selection, which includes thorough preoperative assessment, imaging studies, and histopathological evaluation to ensure that the disease is confined to one ovary and that there are no adverse prognostic factors present[ 15 ]. The psychological and emotional dimensions of a cancer diagnosis cannot be overlooked, particularly in younger women who may be facing the prospect of infertility. The desire for future childbearing is a significant concern for many patients, and the option of FSS can provide a sense of hope and agency in an otherwise challenging situation[ 16 – 18 ]. Studies have documented successful pregnancies following FSS, further emphasizing the importance of this approach in preserving not only fertility but also the overall quality of life for survivors[ 19 ]. The emotional burden of cancer treatment extend beyond physical health, and the ability to conceive post-treatment can play a crucial role in a woman's psychological well-being[ 20 ]. However, it is essential to acknowledge that FSS is not devoid of risks. The potential for recurrence remains a critical consideration, and patients must be counseled about the implications of choosing a fertility-sparing approach. The risk of recurrence may necessitate subsequent treatments, including chemotherapy, which can further complicate reproductive outcomes[ 21 ]. Therefore, a multidisciplinary approach involving oncologists, reproductive endocrinologists, and mental health professionals is vital in guiding patients through the decision-making process regarding FSS[ 22 ]. In conclusion, the landscape of treatment for Stage I ovarian cancer is evolving, with FSS emerging as a promising option for women desiring to preserve their fertility. The existing literature supports the oncological safety of this approach, particularly in well-selected patients with favourable tumor characteristics. As the body of evidence continues to grow, it is imperative for clinicians to remain informed about the latest findings and guidelines to provide optimal care for their patients. Future research should focus on long-term outcomes, including recurrence rates and the psychological impact of FSS on patients. Review question What are the reproductive outcomes in women with stage I (FIGO categorization) ovarian cancer who undergo fertility-sparing surgery? Methods Inclusion Criteria This study focused on women diagnosed with stage I ovarian cancer according to FIGO staging, specifically those under 50 years of age. Inclusion criteria required participants to express a desire for fertility preservation and to be candidates for fertility-sparing surgery. The selection criteria were established based on existing research evidence supporting the safety and efficacy of fertility-sparing interventions in this population. By targeting this demographic, the study aimed to assess the outcomes and effectiveness of fertility-sparing approaches in young women with ovarian cancer. Exclusion Criteria Women diagnosed with advanced-stage ovarian cancer (beyond FIGO stage I), those aged 50 years or older, and individuals who had undergone prior bilateral oophorectomy were excluded from the study. Additionally, participants who did not express an interest in fertility preservation or had concurrent gynecological malignancies were also excluded. These criteria ensured that the study focused on a population that could benefit from fertility-sparing surgical interventions. Concept Fertility-sparing surgery (FSS) in this study refers to surgical procedures designed to treat early-stage ovarian cancer while preserving reproductive potential. This approach is particularly significant for women diagnosed with stage I ovarian cancer as it addresses both oncological and reproductive considerations. Specific exclusion criteria based on this concept included individuals diagnosed with advanced-stage ovarian cancer, those aged 50 years or older, patients with prior bilateral oophorectomy, those uninterested in fertility preservation, and those with other concurrent gynecological malignancies. These criteria ensured the study focused on an appropriate population for meaningful analysis of FSS outcomes. Types of Sources This systematic review considered various study designs, including case-control studies, cohort studies, randomized controlled trials, and non-randomized controlled trials. Analytical observational studies, including prospective and retrospective cohort studies, case-control studies, and analytical cross-sectional studies, were included. Additionally, descriptive observational studies such as case series, individual case reports, and descriptive cross-sectional studies were reviewed. Systematic reviews, meta-analyses, text and opinion papers were excluded. Search Strategy A comprehensive three-step search strategy was implemented to identify both published and unpublished studies. Initially, a limited search of MEDLINE (PubMed), SCOPUS, and Google Scholar was conducted to identify relevant articles (Fig. 1 ). The key terms and index terms extracted from these articles were then used to develop a complete search strategy for MEDLINE, SCOPUS, and Google Scholar. The strategy was adapted for each database, and the reference lists of included studies were also screened for additional sources. Only studies published in English since 2015 were included, given the significant volume of recent research in this area. Unpublished studies and gray literature were not included in the search strategy. Data extraction Data will be extracted from papers included in the scoping review by two independent reviewers using a data extraction tool developed by the reviewers (JBI SUMARI)[ 23 ]. The data extracted will include specific details about the participants, concept, context, study methods and key findings relevant to the review question. The draft data extraction tool will be modified and revised as necessary during the process of extracting data from each included evidence source. Modifications will be detailed in the scoping review. Any disagreements that arise between the reviewers will be resolved through discussion, or with an additional reviewer/s. If appropriate, authors of papers will be contacted to request missing or additional data, where required. Study Selection and Data Management All identified citations were imported into EndNote 21.5, where duplicates were removed. Following a pilot test, titles and abstracts were screened independently by two or more reviewers against the inclusion criteria[ 24 ]. Potentially relevant studies were retrieved in full, with citation details imported into JBI SUMARI for further assessment. Full-text screening was conducted by two independent reviewers, with disagreements resolved through discussion. Reasons for excluding full-text studies were recorded and reported. The study selection process was documented in a PRISMA flow diagram for transparency and reproducibility. This methodological framework ensured a rigorous and systematic approach to evaluating the impact of fertility-sparing surgery in young women diagnosed with early-stage ovarian cancer. Quality Assessment of The Studies The critical appraisal of the included studies was conducted using the JBI SUMARI tool, which provides a comprehensive framework for assessing methodological quality across various study designs[ 23 ]. The evaluation considered the thematic focus and study type, ensuring an appropriate appraisal based on the best available evidence for the "symptom prevalence study" scenario. Studies were rated as good, fair, or poor according to established criteria, ensuring consistency in quality assessment. Two independent researchers carried out the appraisal, and any discrepancies were resolved through consensus to enhance reliability. By employing JBI SUMARI, this process ensured a rigorous and transparent evaluation, minimizing bias and strengthening the validity of the synthesized findings (Appendix II). Results A total of 17 studies, comprising 1030 patients diagnosed with FIGO stage I ovarian cancer, were included in this systematic review. The mean patient age varied across studies, ranging from 23.7 to 34 years. The included studies reported on a range of histological subtypes, with epithelial ovarian tumors being the most common, including serous, mucinous, endometrioid, and clear cell carcinoma. Non-epithelial tumors, such as dysgerminoma and Sertoli-Leydig tumors, were also represented, though to a lesser extent. The tumor grade distribution was diverse, with many patients presenting with low-grade (Grade 1 or 2) tumors, which are generally considered more favorable for fertility preservation. FIGO staging among the studies demonstrated that most patients underwent FSS for Stage IA disease, while Stage IC subtypes accounted for a significant proportion, particularly Stage IC1 and IC2. A small number of studies included patients with Stage IC3 disease, though these cases were less frequent due to higher recurrence risks associated with peritoneal involvement. Reproductive Outcomes The ability to conceive and carry a pregnancy to term was a key outcome assessed across the included studies. Among patients who actively attempted pregnancy, success rates varied significantly, ranging from 25–91.3%. Most studies reported successful conception in at least 60% of patients attempting pregnancy. However, the overall pregnancy rate among all patients who underwent FSS (including those who did not attempt pregnancy) varied from 9.5–68%. Live birth rates were similarly high, ranging from 62.5–100%, with most studies exceeding 80%. Notably, patients who had longer follow-up durations tended to have higher pregnancy rates, suggesting that some may have delayed childbearing due to personal, medical, or oncologic considerations. The majority of pregnancies were achieved through spontaneous conception, although assisted reproductive technologies (ART) played a role in a subset of patients. The use of ART, including in vitro fertilization (IVF) and embryo transfer (ET), was reported in 3.7–28% of patients. Some studies noted that patients who had undergone chemotherapy exhibited slightly lower pregnancy rates, though many were still able to conceive either spontaneously or with ART. Despite a significant proportion of patients (58%) expressing a desire for future pregnancy post-treatment, only 13% actively attempted conception in some studies. This discrepancy highlights potential barriers to achieving pregnancy, such as concerns about oncologic recurrence, personal choices, and accessibility to fertility treatments. Regarding pregnancy complications, most studies reported low rates of adverse events. Preterm birth rates ranged from 6.25–22.2%, while gestational complications such as gestational diabetes and preeclampsia were relatively rare. Cesarean section rates were high in some cohorts, possibly reflecting obstetricians' cautious approach to pregnancy in cancer survivors. Oncologic Outcomes The oncologic safety of FSS remains a critical consideration, and recurrence rates varied across studies, ranging from 3–33.3%. However, the majority of studies reported recurrence rates between 8% and 15%. The five-year disease-free survival (DFS) rate remained above 90% in most studies, reinforcing the safety of FSS in well-selected patients. Overall survival (OS) rates were also favorable, ranging from 88–100%, with most studies reporting survival rates exceeding 95%. Patients with complete surgical staging had better oncologic outcomes, supporting the importance of a thorough peritoneal assessment, including peritoneal washings and lymphadenectomy, in reducing recurrence risk. Histological subtype and FIGO staging played a significant role in recurrence risk. Mucinous ovarian carcinoma and higher-risk subtypes of FIGO Stage IC (IC2 and IC3) were associated with increased recurrence rates. The most common sites of recurrence included the contralateral ovary and the peritoneal cavity. In most cases, recurrence was managed successfully with secondary radical surgery and chemotherapy. Chemotherapy Utilization in Fertility-Sparing Surgery (FSS) Chemotherapy administration varied across studies, ranging from 9.1–94.4%. The highest rates were reported by Park et al. (2016) ( 94.4% ) and Jiang et al. (2017) ( 76.9% ) , while the lowest was noted in Swift et al. (2022) ( 9.1% ). Moderate usage was observed in Birge et al. (2022) ( 43.75% ) , Ghalleb et al. (2019) ( 50% ) , and Chen et al. (2020) ( 32.2% ). Chemotherapy and Reproductive Outcomes Some studies reported successful pregnancies post-chemotherapy. Agulto-Mercadal et al. (2020) noted three patients who conceived post-treatment, while Watanabe et al. (2020) found 80% of chemotherapy-exposed patients achieved pregnancy. However, Johansen et al. (2020) reported 17% infertility, and Abdelsalam et al. (2022) found 20% unable to conceive due to recurrence. Recurrence and Survival in Chemotherapy-Treated Patients Recurrence rates ranged from 3–20%, with survival exceeding 85% in all studies. Park et al. (2016) reported 5.6% recurrence, and Ko et al. (2023) found 3% recurrence despite chemotherapy. Johansen et al. (2020) reported a 5-year OS of 97% in FSS patients versus 89% in radical surgery patients, while Lin et al. (2022) noted 98.6% OS in the FSS group. Surgical Approach The predominant surgical approach in FSS was unilateral salpingo-oophorectomy (USO), performed with or without complete surgical staging. Some studies also reported cases of bilateral salpingo-oophorectomy with uterine preservation, though this approach was less common due to its impact on ovarian function and fertility potential. Minimally invasive surgery (laparoscopy) was utilized in 15.2–54.8% of cases, but laparotomy remained the preferred surgical method in the majority of studies. The concern regarding the adequacy of staging in laparoscopic procedures remains a debated topic, as laparotomy allows for a more extensive surgical assessment. The extent of surgical staging varied, with some studies performing comprehensive peritoneal staging and lymphadenectomy. Patients who underwent complete surgical staging had lower recurrence rates, reinforcing its role in improving oncologic outcomes. Main Findings and Clinical Implications The findings of this systematic review suggest that FSS is a viable and safe option for young women diagnosed with early-stage ovarian cancer who wish to preserve fertility. Oncologic outcomes appear comparable to those achieved with radical surgery in well-selected patients, particularly when complete surgical staging is performed. Reproductive outcomes following FSS are encouraging, with high pregnancy and live birth rates reported. The role of ART in enhancing fertility outcomes is notable, although spontaneous conception remains the predominant method of achieving pregnancy. However, the observed gap between fertility intention and actual pregnancy attempts suggests that additional support and fertility counseling may be necessary for cancer survivors. Moving forward, careful patient selection remains crucial, particularly for those with Stage IC disease or histologic subtypes associated with higher recurrence risk. Future research should focus on long-term oncologic safety, optimization of fertility preservation techniques, and the psychological impact of FSS on patients' reproductive decision-making. Discussion Fertility-sparing surgery (FSS) has emerged as a viable alternative to radical surgery for young women diagnosed with early-stage ovarian cancer, particularly those who wish to preserve their reproductive potential. The findings from the reviewed studies suggest that FSS provides comparable oncological outcomes to radical surgery, reinforcing its role as a treatment option in well-selected patients. However, careful consideration must be given to patient selection, tumor histology, surgical approach, and long-term reproductive counseling to balance oncologic safety with fertility preservation. Oncological Safety of Fertility-Sparing Surgery The oncological outcomes of FSS remain a primary concern when considering its implementation in clinical practice. The studies analyzed reported recurrence rates ranging from 3–33.3%, with most between 8% and 15%, and an overall survival (OS) rate of 88–100%, demonstrating that FSS does not significantly compromise survival in well-selected patients. These findings align with previous studies indicating that patients with stage IA and select IC tumors, particularly those with non-aggressive histological subtypes, can achieve long-term survival comparable to those undergoing radical surgery[ 25 – 28 ]. One of the key determinants of oncologic outcomes is tumor histology and FIGO staging. The studies showed that mucinous ovarian carcinoma and higher FIGO IC subtypes (IC2 and IC3) carry a higher risk of recurrence, emphasizing the importance of rigorous staging and postoperative surveillance in these patients[ 15 , 26 , 29 – 37 ]. Moreover, most recurrences occurred in the contralateral ovary and peritoneum, suggesting that bilateral ovarian monitoring and complete surgical staging are crucial for detecting early disease relapse[ 15 ]. The studies also demonstrated that most recurrences were successfully treated with secondary radical surgery and chemotherapy, reinforcing the potential for disease control even in cases of recurrence[ 37 ]. Another critical factor influencing oncologic safety is the extent of surgical staging. Patients who underwent comprehensive peritoneal assessment, including lymphadenectomy and peritoneal washings, had lower recurrence rates, highlighting the importance of adequate staging to identify micro metastatic disease[ 38 ]. Given that incomplete staging may lead to underestimation of disease burden, patients with inadequate staging may require additional surveillance or even adjuvant chemotherapy to reduce recurrence risk[ 39 , 40 ]. Overall, these findings underscore that FSS can be safely performed in well-selected patients, provided that comprehensive surgical staging and strict postoperative follow-up are ensured. Future research should explore molecular and genetic markers to further refine patient selection criteria, allowing for even more individualized treatment decisions. Reproductive Outcomes and Fertility Potential The studies included in this review demonstrate encouraging reproductive outcomes following FSS, with pregnancy success rates ranging from 25–91.3% among patients attempting conception. The total pregnancy rate varied from 9.5–68%, reflecting differences in study populations, follow-up duration, and fertility preservation strategies. Importantly, live birth rates ranged from 62.5–100%, with most studies reporting rates above 80%, reinforcing the notion that successful pregnancy and childbirth are achievable following FSS[ 26 ]. Interestingly, most pregnancies were spontaneous, with only 3.7–28% of patients requiring ART such as IVF[ 7 , 26 , 33 , 37 , 41 ]. This suggests that ovarian function can be successfully maintained in most patients undergoing FSS, although some patients, particularly those who received chemotherapy, may require ART assistance. Studies with longer follow-up durations reported higher pregnancy rates, indicating that some patients may delay conception due to oncologic concerns, personal choices, or fertility treatment access[ 42 , 43 ]. Despite these promising fertility outcomes, the review also highlights a notable gap between fertility intention and actual pregnancy attempts. While 58% of patients expressed a desire for children post-treatment, only 13% actively attempted conception in some studies[ 44 ]. This discrepancy suggests that psychosocial factors, fear of recurrence, and lack of fertility counseling may play significant roles in influencing reproductive decisions. Future studies should explore barriers to post-treatment conception and the impact of fertility counseling on improving pregnancy rates. Additionally, early integration of reproductive specialists into oncologic care may facilitate better fertility preservation strategies and optimize pregnancy outcomes. Another important consideration is pregnancy safety following FSS. The review found that preterm birth rates ranged from 6.25–22.2%, with only a few reported cases of pregnancy complications[ 30 , 33 , 37 , 45 ]. While these rates are comparable to those seen in the general population, ongoing monitoring of maternal and neonatal outcomes is essential to ensure that pregnancy following FSS does not pose additional risks. Surgical Approach and Impact on Outcomes The surgical approach plays a critical role in both oncological and reproductive outcomes following FSS. The studies reviewed indicate that the most common surgical procedure was unilateral salpingo-oophorectomy (USO), with or without complete staging. However, some studies included cases of bilateral salpingo-oophorectomy with uterine preservation, which may further reduce recurrence risk but limit future reproductive options[ 15 ]. Regarding surgical technique, laparoscopy was performed in 15.2–54.8% of cases, while laparotomy remained the preferred approach in many patients. Although laparoscopy is associated with faster recovery times and fewer postoperative complications, concerns remain regarding the adequacy of surgical staging and potential risk of tumor spillage[ 46 ]. The ongoing debate regarding the role of minimally invasive surgery in FSS highlights the need for randomized trials comparing oncological and reproductive outcomes between laparoscopy and laparotomy in early-stage ovarian cancer. Additionally, chemotherapy use varied between studies, ranging from 34–94.4% of patients. While some studies suggested that chemotherapy may slightly reduce pregnancy rates, others demonstrated that patients who received chemotherapy were still able to conceive naturally or with ART. This suggests that the gonadotoxic effects of chemotherapy may not be as detrimental in early-stage ovarian cancer as previously thought. However, the necessity of chemotherapy was associated with higher recurrence rates, reinforcing the need for careful patient selection to balance oncologic safety with fertility preservation. Clinical Implications and Future Directions The findings of this review support the use of FSS as a safe and effective fertility-preserving treatment for young patients with early-stage ovarian cancer. However, with patient selection based on tumor histology, FIGO staging, and the presence of high-risk features. The importance of complete surgical staging cannot be overstated, as inadequate staging may lead to underdiagnosis of metastatic disease and increased recurrence risk. Moving forward, more robust long-term studies are needed to assess fertility outcomes beyond the typical follow-up period. Additionally, improving fertility counseling and access to reproductive specialists is critical to ensuring that patients who desire pregnancy receive appropriate guidance and support. Future research should also focus on the impact of ART on oncological outcomes, as well as optimizing fertility preservation strategies before and after treatment. Finally, molecular profiling and predictive biomarkers could help further refine patient selection, identifying those who are most likely to benefit from FSS while minimizing recurrence risk[ 47 ]. As research advances, the integration of personalized medicine into fertility-preserving treatment protocols may help optimize both survival and reproductive outcomes for young women with ovarian cancer[ 48 ]. Conclusion This systematic review highlights the feasibility and safety of FSS for young women diagnosed with early-stage ovarian cancer. The findings indicate that FSS offers a viable option for preserving reproductive potential without significantly compromising oncologic outcomes. Recurrence rates remain within acceptable limits, and overall survival rates are comparable to those observed with radical surgical interventions. Reproductive outcomes following FSS are promising, with high conception and live birth rates, particularly in well-selected patients. The use of ART has further enhanced the likelihood of successful pregnancies. However, challenges remain, including the increased miscarriage rates and the potential long-term oncologic risks, necessitating careful patient selection and ongoing surveillance. The psychosocial impact of fertility preservation in young cancer patients underscores the need for a multidisciplinary approach to patient care. Oncologists, reproductive specialists, and mental health professionals should collaborate to provide comprehensive counseling and support throughout the decision-making process. Future research should focus on long-term oncologic safety, the optimization of fertility preservation strategies, and the psychosocial implications of FSS. As advancements in oncologic and reproductive medicine continue to evolve, it is crucial to refine treatment protocols to ensure that young women diagnosed with early-stage ovarian cancer receive the best possible care, balancing oncologic safety with reproductive goals. Declarations Author’s Contribution Protocol/project development SSC and CS contributed equally to protocol/project development Data collection or management Data collection was done by SCC. Data analysis Data analysis was done by both SSC and CS Manuscript writing/editing SSC and CS contributed equally to manuscript writing/editing Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflicts of interest There is no conflict of interest between the authors. References Vasta FM, Cormio G, Cassani C, Bergamini A, Scarfone G, Ferrandina G et al (2024) Reproductive outcomes after conservative treatment in early and advanced stage MOGCTs. Gynecol Oncol 181:28–32 McMullen M, Karakasis K, Rottapel R, Oza AM (2021) Advances in ovarian cancer, from biology to treatment. 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J Gynecol Oncol 25(4):320–327 Chen J, Wang F-F, Zhang Y, Yang B, Ai J-H, Wang X-Y et al (2020) Oncological and Reproductive Outcomes of Fertility-sparing Surgery in Women with Early-stage Epithelial Ovarian Carcinoma: A Multicenter Retrospective Study. Curr Med Sci 40(4):745–752 Armstrong DK, Alvarez RD, Bakkum-Gamez JN, Barroilhet L, Behbakht K, Berchuck A et al (2021) Ovarian Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 19(2):191–226 Smeenk J, Wyns C, De Geyter C, Kupka M, Bergh C, Cuevas Saiz I et al (2023) ART in Europe, 2019: results generated from European registries by ESHRE†. Hum Reprod 38(12):2321–2338 Brezina PR, Ding J, Ke RW, Klosky JL, Tillmanns TD (2015) Fertility Preservation Through Oocyte Cryopreservation in a Patient with Ovarian Dysgerminocarcinoma: A Case Report. J Reprod Med 60(9–10):441–444 Agulto-Mercadal MC, Cole LMT, Santos RAR (2020) Reproductive outcome of FIGO stage IA and IC ovarian cancer after fertility-sparing surgery: A retrospective cohort study. Philippine J Obstet Gynecol 44(1):10–17 Park J-Y, Heo EJ, Lee J-W, Lee Y-Y, Kim T-J, Kim B-G et al (2016) Outcomes of laparoscopic fertility-sparing surgery in clinically early-stage epithelial ovarian cancer. J Gynecologic Oncol. ;27(2) Watanabe T, Soeda S, Nishiyama H, Kiko Y, Tokunaga H, Shigeta S et al (2020) Clinical and reproductive outcomes of fertility-sparing surgery in stage I epithelial ovarian cancer. Mol Clin Oncol 12(1):44–50 Ko ME, Lin YH, Huang KJ, Chang WC, Sheu BC (2023) Fertility and Pregnancy Outcomes after Fertility-Sparing Surgery for Early-Stage Borderline Ovarian Tumors and Epithelial Ovarian Cancer: A Single-Center Study. Cancers (Basel). ;15(22) Abdelsalam WA, Etman W, Harb OA, Abdelfattah AR, Balata R, Abohashim MF (2022) Value of fertility-sparing surgery for young females with epithelial ovarian cancer: a comparative study. Ginecol Obstet Mex 90(5):427–433 Johansen G, Dahm-Kähler P, Staf C, Flöter Rådestad A, Rodriguez-Wallberg KA (2020) A Swedish Nationwide prospective study of oncological and reproductive outcome following fertility-sparing surgery for treatment of early stage epithelial ovarian cancer in young women. BMC Cancer. ;20(1) Khatun S, Deeba F, Alam ABMM, Ivy R, Parveen F (2020) Fertility-sparing Surgery (FSS) in Epithelial Ovarian Cancer (EOC): A Case Report. Bangladesh J Obstet Gynecol 35(1):46–48 Lin W, Cao D, Shi X, You Y, Yang J, Shen K (2022) Oncological and Reproductive Outcomes After Fertility-Sparing Surgery for Stage I Mucinous Ovarian Carcinoma. Front Oncol 12:856818 Schlaerth AC, Chi DS, Poynor EA, Barakat RR, Brown CL (2009) Long-Term Survival After Fertility-Sparing Surgery for Epithelial Ovarian Cancer. Int J Gynecol Cancer 19(7):1199–1204 Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17(6):1471–1474 NCCN Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer 2025 [Available from: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1453 Park JY, Heo EJ, Lee JW, Lee YY, Kim TJ, Kim BG et al (2016) Outcomes of laparoscopic fertility-sparing surgery in clinically early-stage epithelial ovarian cancer. J Gynecol Oncol 27(2):e20 Moravek MB, Confino R, Smith KN, Kazer RR, Klock SC, Lawson AK et al (2018) Long-term outcomes in cancer patients who did or did not pursue fertility preservation. Fertil Steril 109(2):349–355 Porcu E, Cipriani L, Dirodi M, De Iaco P, Perrone AM, Zinzani PL et al (2022) Successful Pregnancies, Births, and Children Development Following Oocyte Cryostorage in Female Cancer Patients During 25 Years of Fertility Preservation. Cancers (Basel). ;14(6) Letourneau J, Chan J, Salem W, Chan SW, Shah M, Ebbel E et al (2015) Fertility Sparing Surgery for Localized Ovarian Cancers Maintains an Ability to Conceive, but is Associated With Diminished Reproductive Potential. J Surg Oncol 112(1):26–30 Jiang X, Yang J, Yu M, Xie W, Cao D, Wu M et al (2017) Oncofertility in patients with stage I epithelial ovarian cancer: fertility-sparing surgery in young women of reproductive age. World J Surg Oncol 15(1):154 Cirocchi R, Soreide K, Di Saverio S, Rossi E, Arezzo A, Zago M et al (2018) Meta-analysis of perioperative outcomes of acute laparoscopic versus open repair of perforated gastroduodenal ulcers. J Trauma Acute Care Surg 85(2):417–425 Moore DC, Guinigundo AS (2023) Revolutionizing Cancer Treatment: Harnessing the Power of Biomarkers to Improve Patient Outcomes. J Adv Pract Oncol 14(Suppl 1):4–8 Silvestris E, Paradiso AV, Minoia C, Daniele A, Cormio G, Tinelli R et al (2022) Fertility preservation techniques in cervical carcinoma. Med (Baltim) 101(17):e29163 Tables Table 1 is available in the Supplementary Files section. Additional Declarations The authors declare no competing interests. Supplementary Files Appendices.docx Table1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6115489","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":421439385,"identity":"1c2a80c0-03bc-4aef-ad19-9634e1b0afd4","order_by":0,"name":"Stylianos Sergios Chatziioannou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYHACxgMJYDr58IMPQIqNnZAGNgYGqJa0NMMZIAFmYrRAWDkG0jwgmpAW+fnNBw48qKiL5mfPMTC2+bVNno+ZgfHDxxzcWgyOsSUcSDhzOHdmz7OCx7l9tw3bmBmYJWduw6OFjcfgQGLbgdwNN5I3GOf23GYEamFj5sWjRb6N/wNQS13u/hsJBtKWPbftCWphOMbDANTCnLtBIsVAmuHH7USCWgyOpRmA/TLjzLM0w96G28ltzIzNeP0i33z44cMfFXW5/e3AqPzx57bt/Pbmgx8+4nMYCmBsA5MNxKoHgT+kKB4Fo2AUjIKRAgBYpVhS7xVQswAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0008-6394-1891","institution":"European University of Cyprus, Nicosia, Cyprus","correspondingAuthor":true,"prefix":"","firstName":"Stylianos","middleName":"Sergios","lastName":"Chatziioannou","suffix":""},{"id":421439386,"identity":"24aaf6dd-8cf5-49fb-9da7-9e75b9947716","order_by":1,"name":"Chrisostomos Sofoudis","email":"","orcid":"","institution":"1st Department of General Maternity Hospital, Elena Venizelou, Athens, Greece","correspondingAuthor":false,"prefix":"","firstName":"Chrisostomos","middleName":"","lastName":"Sofoudis","suffix":""}],"badges":[],"createdAt":"2025-02-26 18:25:38","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6115489/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6115489/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77393380,"identity":"2c03ed2a-0c68-4bb2-8ca1-79459176e57c","added_by":"auto","created_at":"2025-02-28 07:02:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":85206,"visible":true,"origin":"","legend":"\u003cp\u003ePrisma flowchart\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6115489/v1/fe74b6f38800dafacefc2733.png"},{"id":77393383,"identity":"3907bb23-1bea-4cdc-a80a-462f81937728","added_by":"auto","created_at":"2025-02-28 07:02:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":529506,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6115489/v1/1949613f-c57c-4602-a916-a507159f0178.pdf"},{"id":77392875,"identity":"b1976f13-66fc-459f-ad1d-8d00483f4b6a","added_by":"auto","created_at":"2025-02-28 06:54:12","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18747,"visible":true,"origin":"","legend":"","description":"","filename":"Appendices.docx","url":"https://assets-eu.researchsquare.com/files/rs-6115489/v1/fdaf373aa5adc2bdd29d8466.docx"},{"id":77393379,"identity":"a84a91b0-6b26-4e89-8dc0-4ba0807f6f24","added_by":"auto","created_at":"2025-02-28 07:02:12","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":49106,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6115489/v1/5bc07a836416bfda956016b4.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eFertility Sparing Surgery Upon Reproductive and Oncologic results in Ovarian Cancer patients Stage I (FIGO): A Systematic Review\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFertility-sparing surgery (FSS) in the context of early-stage ovarian cancer, specifically Stage I as classified by the FIGO, represents a critical intersection of oncological treatment and reproductive health[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The diagnosis of ovarian cancer, particularly in younger women, poses significant challenges not only in terms of survival but also regarding the preservation of fertility[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As the incidence of ovarian cancer in women of reproductive age continues to be a pressing concern, the exploration of FSS as a viable treatment option has garnered increasing attention within the medical community[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This systematic review aims to synthesize the existing literature on FSS for Stage I ovarian cancer, evaluating both oncological outcomes and reproductive implications, thereby providing a comprehensive overview for clinicians and patients alike.\u003c/p\u003e \u003cp\u003eThe significance of FSS arises from the unique demographic of women affected by ovarian cancer. Approximately 10% of ovarian cancer cases occur in women under the age of 40, a population that often prioritizes the preservation of reproductive potential alongside effective cancer treatment[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Traditional treatment paradigms for ovarian cancer have typically involved radical surgical approaches, including total abdominal hysterectomy and bilateral salpingo-oophorectomy, which inherently compromise fertility[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, the evolving understanding of the biology of early-stage ovarian cancer, particularly low-grade tumors and certain histological subtypes, has led to a revaluation of treatment strategies that prioritize both oncological safety and reproductive desires[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe current clinical guidelines from organizations such as the American College of Obstetricians and Gynaecologists (ACOG) and the European Society for Medical Oncology (ESMO) endorse FSS for select patients with Stage I ovarian cancer, particularly those with favourable tumor characteristics[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These guidelines reflect a growing consensus that, in appropriately selected cases, FSS can achieve comparable oncological outcomes to radical surgery while allowing for the preservation of the uterus and at least one ovary. The oncological safety of FSS has been supported by numerous studies indicating that women undergoing FSS for Stage I ovarian cancer experience similar rates of overall survival and disease-free survival compared to those undergoing more radical interventions[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTwo meta-analysis conducted highlighted that FSS does not significantly compromise survival outcomes in women with early-stage epithelial ovarian cancer, suggesting that the oncological risks associated with this approach may be minimal when performed in a controlled setting[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Furthermore, specific histological subtypes, such as mucinous and endometrioid ovarian cancers, have shown favourable outcomes with FSS, reinforcing the notion that individualized treatment plans based on tumor biology can enhance both survival and reproductive prospects[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The ability to perform FSS safely hinges on careful patient selection, which includes thorough preoperative assessment, imaging studies, and histopathological evaluation to ensure that the disease is confined to one ovary and that there are no adverse prognostic factors present[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe psychological and emotional dimensions of a cancer diagnosis cannot be overlooked, particularly in younger women who may be facing the prospect of infertility. The desire for future childbearing is a significant concern for many patients, and the option of FSS can provide a sense of hope and agency in an otherwise challenging situation[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Studies have documented successful pregnancies following FSS, further emphasizing the importance of this approach in preserving not only fertility but also the overall quality of life for survivors[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The emotional burden of cancer treatment extend beyond physical health, and the ability to conceive post-treatment can play a crucial role in a woman's psychological well-being[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, it is essential to acknowledge that FSS is not devoid of risks. The potential for recurrence remains a critical consideration, and patients must be counseled about the implications of choosing a fertility-sparing approach. The risk of recurrence may necessitate subsequent treatments, including chemotherapy, which can further complicate reproductive outcomes[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Therefore, a multidisciplinary approach involving oncologists, reproductive endocrinologists, and mental health professionals is vital in guiding patients through the decision-making process regarding FSS[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn conclusion, the landscape of treatment for Stage I ovarian cancer is evolving, with FSS emerging as a promising option for women desiring to preserve their fertility. The existing literature supports the oncological safety of this approach, particularly in well-selected patients with favourable tumor characteristics. As the body of evidence continues to grow, it is imperative for clinicians to remain informed about the latest findings and guidelines to provide optimal care for their patients. Future research should focus on long-term outcomes, including recurrence rates and the psychological impact of FSS on patients.\u003c/p\u003e \u003cp\u003eReview question\u003c/p\u003e \u003cp\u003eWhat are the reproductive outcomes in women with stage I (FIGO categorization) ovarian cancer who undergo fertility-sparing surgery?\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eInclusion Criteria\u003c/p\u003e \u003cp\u003e This study focused on women diagnosed with stage I ovarian cancer according to FIGO staging, specifically those under 50 years of age. Inclusion criteria required participants to express a desire for fertility preservation and to be candidates for fertility-sparing surgery. The selection criteria were established based on existing research evidence supporting the safety and efficacy of fertility-sparing interventions in this population. By targeting this demographic, the study aimed to assess the outcomes and effectiveness of fertility-sparing approaches in young women with ovarian cancer.\u003c/p\u003e \u003cp\u003eExclusion Criteria\u003c/p\u003e \u003cp\u003eWomen diagnosed with advanced-stage ovarian cancer (beyond FIGO stage I), those aged 50 years or older, and individuals who had undergone prior bilateral oophorectomy were excluded from the study. Additionally, participants who did not express an interest in fertility preservation or had concurrent gynecological malignancies were also excluded. These criteria ensured that the study focused on a population that could benefit from fertility-sparing surgical interventions.\u003c/p\u003e \u003cp\u003eConcept\u003c/p\u003e \u003cp\u003eFertility-sparing surgery (FSS) in this study refers to surgical procedures designed to treat early-stage ovarian cancer while preserving reproductive potential. This approach is particularly significant for women diagnosed with stage I ovarian cancer as it addresses both oncological and reproductive considerations. Specific exclusion criteria based on this concept included individuals diagnosed with advanced-stage ovarian cancer, those aged 50 years or older, patients with prior bilateral oophorectomy, those uninterested in fertility preservation, and those with other concurrent gynecological malignancies. These criteria ensured the study focused on an appropriate population for meaningful analysis of FSS outcomes.\u003c/p\u003e \u003cp\u003eTypes of Sources\u003c/p\u003e \u003cp\u003eThis systematic review considered various study designs, including case-control studies, cohort studies, randomized controlled trials, and non-randomized controlled trials. Analytical observational studies, including prospective and retrospective cohort studies, case-control studies, and analytical cross-sectional studies, were included. Additionally, descriptive observational studies such as case series, individual case reports, and descriptive cross-sectional studies were reviewed. Systematic reviews, meta-analyses, text and opinion papers were excluded.\u003c/p\u003e \u003cp\u003eSearch Strategy\u003c/p\u003e \u003cp\u003eA comprehensive three-step search strategy was implemented to identify both published and unpublished studies. Initially, a limited search of MEDLINE (PubMed), SCOPUS, and Google Scholar was conducted to identify relevant articles (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The key terms and index terms extracted from these articles were then used to develop a complete search strategy for MEDLINE, SCOPUS, and Google Scholar. The strategy was adapted for each database, and the reference lists of included studies were also screened for additional sources. Only studies published in English since 2015 were included, given the significant volume of recent research in this area. Unpublished studies and gray literature were not included in the search strategy.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eData extraction\u003c/p\u003e \u003cp\u003eData will be extracted from papers included in the scoping review by two independent reviewers using a data extraction tool developed by the reviewers (JBI SUMARI)[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The data extracted will include specific details about the participants, concept, context, study methods and key findings relevant to the review question.\u003c/p\u003e \u003cp\u003eThe draft data extraction tool will be modified and revised as necessary during the process of extracting data from each included evidence source. Modifications will be detailed in the scoping review. Any disagreements that arise between the reviewers will be resolved through discussion, or with an additional reviewer/s. If appropriate, authors of papers will be contacted to request missing or additional data, where required.\u003c/p\u003e \u003cp\u003eStudy Selection and Data Management\u003c/p\u003e \u003cp\u003eAll identified citations were imported into EndNote 21.5, where duplicates were removed. Following a pilot test, titles and abstracts were screened independently by two or more reviewers against the inclusion criteria[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Potentially relevant studies were retrieved in full, with citation details imported into JBI SUMARI for further assessment. Full-text screening was conducted by two independent reviewers, with disagreements resolved through discussion. Reasons for excluding full-text studies were recorded and reported. The study selection process was documented in a PRISMA flow diagram for transparency and reproducibility.\u003c/p\u003e \u003cp\u003eThis methodological framework ensured a rigorous and systematic approach to evaluating the impact of fertility-sparing surgery in young women diagnosed with early-stage ovarian cancer.\u003c/p\u003e \u003cp\u003eQuality Assessment of The Studies\u003c/p\u003e \u003cp\u003eThe critical appraisal of the included studies was conducted using the JBI SUMARI tool, which provides a comprehensive framework for assessing methodological quality across various study designs[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The evaluation considered the thematic focus and study type, ensuring an appropriate appraisal based on the best available evidence for the \"symptom prevalence study\" scenario. Studies were rated as good, fair, or poor according to established criteria, ensuring consistency in quality assessment. Two independent researchers carried out the appraisal, and any discrepancies were resolved through consensus to enhance reliability. By employing JBI SUMARI, this process ensured a rigorous and transparent evaluation, minimizing bias and strengthening the validity of the synthesized findings (Appendix II).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e A total of 17 studies, comprising 1030 patients diagnosed with FIGO stage I ovarian cancer, were included in this systematic review. The mean patient age varied across studies, ranging from 23.7 to 34 years. The included studies reported on a range of histological subtypes, with epithelial ovarian tumors being the most common, including serous, mucinous, endometrioid, and clear cell carcinoma. Non-epithelial tumors, such as dysgerminoma and Sertoli-Leydig tumors, were also represented, though to a lesser extent. The tumor grade distribution was diverse, with many patients presenting with low-grade (Grade 1 or 2) tumors, which are generally considered more favorable for fertility preservation.\u003c/p\u003e \u003cp\u003eFIGO staging among the studies demonstrated that most patients underwent FSS for Stage IA disease, while Stage IC subtypes accounted for a significant proportion, particularly Stage IC1 and IC2. A small number of studies included patients with Stage IC3 disease, though these cases were less frequent due to higher recurrence risks associated with peritoneal involvement.\u003c/p\u003e \u003cp\u003eReproductive Outcomes\u003c/p\u003e \u003cp\u003eThe ability to conceive and carry a pregnancy to term was a key outcome assessed across the included studies. Among patients who actively attempted pregnancy, success rates varied significantly, ranging from 25\u0026ndash;91.3%. Most studies reported successful conception in at least 60% of patients attempting pregnancy. However, the overall pregnancy rate among all patients who underwent FSS (including those who did not attempt pregnancy) varied from 9.5\u0026ndash;68%.\u003c/p\u003e \u003cp\u003eLive birth rates were similarly high, ranging from 62.5\u0026ndash;100%, with most studies exceeding 80%. Notably, patients who had longer follow-up durations tended to have higher pregnancy rates, suggesting that some may have delayed childbearing due to personal, medical, or oncologic considerations.\u003c/p\u003e \u003cp\u003eThe majority of pregnancies were achieved through spontaneous conception, although assisted reproductive technologies (ART) played a role in a subset of patients. The use of ART, including in vitro fertilization (IVF) and embryo transfer (ET), was reported in 3.7\u0026ndash;28% of patients. Some studies noted that patients who had undergone chemotherapy exhibited slightly lower pregnancy rates, though many were still able to conceive either spontaneously or with ART.\u003c/p\u003e \u003cp\u003eDespite a significant proportion of patients (58%) expressing a desire for future pregnancy post-treatment, only 13% actively attempted conception in some studies. This discrepancy highlights potential barriers to achieving pregnancy, such as concerns about oncologic recurrence, personal choices, and accessibility to fertility treatments.\u003c/p\u003e \u003cp\u003eRegarding pregnancy complications, most studies reported low rates of adverse events. Preterm birth rates ranged from 6.25\u0026ndash;22.2%, while gestational complications such as gestational diabetes and preeclampsia were relatively rare. Cesarean section rates were high in some cohorts, possibly reflecting obstetricians' cautious approach to pregnancy in cancer survivors.\u003c/p\u003e \u003cp\u003eOncologic Outcomes\u003c/p\u003e \u003cp\u003eThe oncologic safety of FSS remains a critical consideration, and recurrence rates varied across studies, ranging from 3\u0026ndash;33.3%. However, the majority of studies reported recurrence rates between 8% and 15%. The five-year disease-free survival (DFS) rate remained above 90% in most studies, reinforcing the safety of FSS in well-selected patients.\u003c/p\u003e \u003cp\u003eOverall survival (OS) rates were also favorable, ranging from 88\u0026ndash;100%, with most studies reporting survival rates exceeding 95%. Patients with complete surgical staging had better oncologic outcomes, supporting the importance of a thorough peritoneal assessment, including peritoneal washings and lymphadenectomy, in reducing recurrence risk.\u003c/p\u003e \u003cp\u003eHistological subtype and FIGO staging played a significant role in recurrence risk. Mucinous ovarian carcinoma and higher-risk subtypes of FIGO Stage IC (IC2 and IC3) were associated with increased recurrence rates. The most common sites of recurrence included the contralateral ovary and the peritoneal cavity. In most cases, recurrence was managed successfully with secondary radical surgery and chemotherapy.\u003c/p\u003e \u003cp\u003eChemotherapy Utilization in Fertility-Sparing Surgery (FSS)\u003c/p\u003e \u003cp\u003eChemotherapy administration varied across studies, ranging from 9.1\u0026ndash;94.4%. The highest rates were reported by Park et al. (2016) \u003cb\u003e(\u003c/b\u003e94.4%\u003cb\u003e)\u003c/b\u003e and Jiang et al. (2017) \u003cb\u003e(\u003c/b\u003e76.9%\u003cb\u003e)\u003c/b\u003e, while the lowest was noted in Swift et al. (2022) \u003cb\u003e(\u003c/b\u003e9.1%\u003cb\u003e).\u003c/b\u003e Moderate usage was observed in Birge et al. (2022) \u003cb\u003e(\u003c/b\u003e43.75%\u003cb\u003e)\u003c/b\u003e, Ghalleb et al. (2019) \u003cb\u003e(\u003c/b\u003e50%\u003cb\u003e)\u003c/b\u003e, and Chen et al. (2020) \u003cb\u003e(\u003c/b\u003e32.2%\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eChemotherapy and Reproductive Outcomes\u003c/p\u003e \u003cp\u003eSome studies reported successful pregnancies post-chemotherapy. Agulto-Mercadal et al. (2020) noted three patients who conceived post-treatment, while Watanabe et al. (2020) found 80% of chemotherapy-exposed patients achieved pregnancy. However, Johansen et al. (2020) reported 17% infertility, and Abdelsalam et al. (2022) found 20% unable to conceive due to recurrence.\u003c/p\u003e \u003cp\u003eRecurrence and Survival in Chemotherapy-Treated Patients\u003c/p\u003e \u003cp\u003eRecurrence rates ranged from 3\u0026ndash;20%, with survival exceeding 85% in all studies. Park et al. (2016) reported 5.6% recurrence, and Ko et al. (2023) found 3% recurrence despite chemotherapy. Johansen et al. (2020) reported a 5-year OS of 97% in FSS patients versus 89% in radical surgery patients, while Lin et al. (2022) noted 98.6% OS in the FSS group.\u003c/p\u003e \u003cp\u003eSurgical Approach\u003c/p\u003e \u003cp\u003eThe predominant surgical approach in FSS was unilateral salpingo-oophorectomy (USO), performed with or without complete surgical staging. Some studies also reported cases of bilateral salpingo-oophorectomy with uterine preservation, though this approach was less common due to its impact on ovarian function and fertility potential.\u003c/p\u003e \u003cp\u003eMinimally invasive surgery (laparoscopy) was utilized in 15.2\u0026ndash;54.8% of cases, but laparotomy remained the preferred surgical method in the majority of studies. The concern regarding the adequacy of staging in laparoscopic procedures remains a debated topic, as laparotomy allows for a more extensive surgical assessment.\u003c/p\u003e \u003cp\u003eThe extent of surgical staging varied, with some studies performing comprehensive peritoneal staging and lymphadenectomy. Patients who underwent complete surgical staging had lower recurrence rates, reinforcing its role in improving oncologic outcomes.\u003c/p\u003e \u003cp\u003eMain Findings and Clinical Implications\u003c/p\u003e \u003cp\u003eThe findings of this systematic review suggest that FSS is a viable and safe option for young women diagnosed with early-stage ovarian cancer who wish to preserve fertility. Oncologic outcomes appear comparable to those achieved with radical surgery in well-selected patients, particularly when complete surgical staging is performed.\u003c/p\u003e \u003cp\u003eReproductive outcomes following FSS are encouraging, with high pregnancy and live birth rates reported. The role of ART in enhancing fertility outcomes is notable, although spontaneous conception remains the predominant method of achieving pregnancy. However, the observed gap between fertility intention and actual pregnancy attempts suggests that additional support and fertility counseling may be necessary for cancer survivors.\u003c/p\u003e \u003cp\u003eMoving forward, careful patient selection remains crucial, particularly for those with Stage IC disease or histologic subtypes associated with higher recurrence risk. Future research should focus on long-term oncologic safety, optimization of fertility preservation techniques, and the psychological impact of FSS on patients' reproductive decision-making.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFertility-sparing surgery (FSS) has emerged as a viable alternative to radical surgery for young women diagnosed with early-stage ovarian cancer, particularly those who wish to preserve their reproductive potential. The findings from the reviewed studies suggest that FSS provides comparable oncological outcomes to radical surgery, reinforcing its role as a treatment option in well-selected patients. However, careful consideration must be given to patient selection, tumor histology, surgical approach, and long-term reproductive counseling to balance oncologic safety with fertility preservation.\u003c/p\u003e \u003cp\u003eOncological Safety of Fertility-Sparing Surgery\u003c/p\u003e \u003cp\u003eThe oncological outcomes of FSS remain a primary concern when considering its implementation in clinical practice. The studies analyzed reported recurrence rates ranging from 3\u0026ndash;33.3%, with most between 8% and 15%, and an overall survival (OS) rate of 88\u0026ndash;100%, demonstrating that FSS does not significantly compromise survival in well-selected patients. These findings align with previous studies indicating that patients with stage IA and select IC tumors, particularly those with non-aggressive histological subtypes, can achieve long-term survival comparable to those undergoing radical surgery[\u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne of the key determinants of oncologic outcomes is tumor histology and FIGO staging. The studies showed that mucinous ovarian carcinoma and higher FIGO IC subtypes (IC2 and IC3) carry a higher risk of recurrence, emphasizing the importance of rigorous staging and postoperative surveillance in these patients[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan additionalcitationids=\"CR30 CR31 CR32 CR33 CR34 CR35 CR36\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Moreover, most recurrences occurred in the contralateral ovary and peritoneum, suggesting that bilateral ovarian monitoring and complete surgical staging are crucial for detecting early disease relapse[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The studies also demonstrated that most recurrences were successfully treated with secondary radical surgery and chemotherapy, reinforcing the potential for disease control even in cases of recurrence[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother critical factor influencing oncologic safety is the extent of surgical staging. Patients who underwent comprehensive peritoneal assessment, including lymphadenectomy and peritoneal washings, had lower recurrence rates, highlighting the importance of adequate staging to identify micro metastatic disease[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Given that incomplete staging may lead to underestimation of disease burden, patients with inadequate staging may require additional surveillance or even adjuvant chemotherapy to reduce recurrence risk[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOverall, these findings underscore that FSS can be safely performed in well-selected patients, provided that comprehensive surgical staging and strict postoperative follow-up are ensured. Future research should explore molecular and genetic markers to further refine patient selection criteria, allowing for even more individualized treatment decisions.\u003c/p\u003e \u003cp\u003eReproductive Outcomes and Fertility Potential\u003c/p\u003e \u003cp\u003eThe studies included in this review demonstrate encouraging reproductive outcomes following FSS, with pregnancy success rates ranging from 25\u0026ndash;91.3% among patients attempting conception. The total pregnancy rate varied from 9.5\u0026ndash;68%, reflecting differences in study populations, follow-up duration, and fertility preservation strategies. Importantly, live birth rates ranged from 62.5\u0026ndash;100%, with most studies reporting rates above 80%, reinforcing the notion that successful pregnancy and childbirth are achievable following FSS[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInterestingly, most pregnancies were spontaneous, with only 3.7\u0026ndash;28% of patients requiring ART such as IVF[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. This suggests that ovarian function can be successfully maintained in most patients undergoing FSS, although some patients, particularly those who received chemotherapy, may require ART assistance. Studies with longer follow-up durations reported higher pregnancy rates, indicating that some patients may delay conception due to oncologic concerns, personal choices, or fertility treatment access[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these promising fertility outcomes, the review also highlights a notable gap between fertility intention and actual pregnancy attempts. While 58% of patients expressed a desire for children post-treatment, only 13% actively attempted conception in some studies[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. This discrepancy suggests that psychosocial factors, fear of recurrence, and lack of fertility counseling may play significant roles in influencing reproductive decisions. Future studies should explore barriers to post-treatment conception and the impact of fertility counseling on improving pregnancy rates. Additionally, early integration of reproductive specialists into oncologic care may facilitate better fertility preservation strategies and optimize pregnancy outcomes.\u003c/p\u003e \u003cp\u003eAnother important consideration is pregnancy safety following FSS. The review found that preterm birth rates ranged from 6.25\u0026ndash;22.2%, with only a few reported cases of pregnancy complications[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. While these rates are comparable to those seen in the general population, ongoing monitoring of maternal and neonatal outcomes is essential to ensure that pregnancy following FSS does not pose additional risks.\u003c/p\u003e \u003cp\u003eSurgical Approach and Impact on Outcomes\u003c/p\u003e \u003cp\u003eThe surgical approach plays a critical role in both oncological and reproductive outcomes following FSS. The studies reviewed indicate that the most common surgical procedure was unilateral salpingo-oophorectomy (USO), with or without complete staging. However, some studies included cases of bilateral salpingo-oophorectomy with uterine preservation, which may further reduce recurrence risk but limit future reproductive options[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding surgical technique, laparoscopy was performed in 15.2\u0026ndash;54.8% of cases, while laparotomy remained the preferred approach in many patients. Although laparoscopy is associated with faster recovery times and fewer postoperative complications, concerns remain regarding the adequacy of surgical staging and potential risk of tumor spillage[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. The ongoing debate regarding the role of minimally invasive surgery in FSS highlights the need for randomized trials comparing oncological and reproductive outcomes between laparoscopy and laparotomy in early-stage ovarian cancer.\u003c/p\u003e \u003cp\u003eAdditionally, chemotherapy use varied between studies, ranging from 34\u0026ndash;94.4% of patients. While some studies suggested that chemotherapy may slightly reduce pregnancy rates, others demonstrated that patients who received chemotherapy were still able to conceive naturally or with ART. This suggests that the gonadotoxic effects of chemotherapy may not be as detrimental in early-stage ovarian cancer as previously thought. However, the necessity of chemotherapy was associated with higher recurrence rates, reinforcing the need for careful patient selection to balance oncologic safety with fertility preservation.\u003c/p\u003e \u003cp\u003eClinical Implications and Future Directions\u003c/p\u003e \u003cp\u003e The findings of this review support the use of FSS as a safe and effective fertility-preserving treatment for young patients with early-stage ovarian cancer. However, with patient selection based on tumor histology, FIGO staging, and the presence of high-risk features. The importance of complete surgical staging cannot be overstated, as inadequate staging may lead to underdiagnosis of metastatic disease and increased recurrence risk.\u003c/p\u003e \u003cp\u003eMoving forward, more robust long-term studies are needed to assess fertility outcomes beyond the typical follow-up period. Additionally, improving fertility counseling and access to reproductive specialists is critical to ensuring that patients who desire pregnancy receive appropriate guidance and support. Future research should also focus on the impact of ART on oncological outcomes, as well as optimizing fertility preservation strategies before and after treatment.\u003c/p\u003e \u003cp\u003eFinally, molecular profiling and predictive biomarkers could help further refine patient selection, identifying those who are most likely to benefit from FSS while minimizing recurrence risk[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. As research advances, the integration of personalized medicine into fertility-preserving treatment protocols may help optimize both survival and reproductive outcomes for young women with ovarian cancer[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e This systematic review highlights the feasibility and safety of FSS for young women diagnosed with early-stage ovarian cancer. The findings indicate that FSS offers a viable option for preserving reproductive potential without significantly compromising oncologic outcomes. Recurrence rates remain within acceptable limits, and overall survival rates are comparable to those observed with radical surgical interventions.\u003c/p\u003e \u003cp\u003eReproductive outcomes following FSS are promising, with high conception and live birth rates, particularly in well-selected patients. The use of ART has further enhanced the likelihood of successful pregnancies. However, challenges remain, including the increased miscarriage rates and the potential long-term oncologic risks, necessitating careful patient selection and ongoing surveillance.\u003c/p\u003e \u003cp\u003eThe psychosocial impact of fertility preservation in young cancer patients underscores the need for a multidisciplinary approach to patient care. Oncologists, reproductive specialists, and mental health professionals should collaborate to provide comprehensive counseling and support throughout the decision-making process.\u003c/p\u003e \u003cp\u003eFuture research should focus on long-term oncologic safety, the optimization of fertility preservation strategies, and the psychosocial implications of FSS. As advancements in oncologic and reproductive medicine continue to evolve, it is crucial to refine treatment protocols to ensure that young women diagnosed with early-stage ovarian cancer receive the best possible care, balancing oncologic safety with reproductive goals.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProtocol/project development\u003c/p\u003e\n\u003cp\u003eSSC and CS contributed equally to protocol/project development\u003c/p\u003e\n\u003cp\u003eData collection or management\u003c/p\u003e\n\u003cp\u003eData collection was done by SCC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was done by both SSC and CS\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eManuscript writing/editing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSSC and CS contributed equally to manuscript writing/editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest between the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVasta FM, Cormio G, Cassani C, Bergamini A, Scarfone G, Ferrandina G et al (2024) Reproductive outcomes after conservative treatment in early and advanced stage MOGCTs. 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Ginecol Obstet Mex 90(5):427\u0026ndash;433\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohansen G, Dahm-K\u0026auml;hler P, Staf C, Fl\u0026ouml;ter R\u0026aring;destad A, Rodriguez-Wallberg KA (2020) A Swedish Nationwide prospective study of oncological and reproductive outcome following fertility-sparing surgery for treatment of early stage epithelial ovarian cancer in young women. BMC Cancer. ;20(1)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhatun S, Deeba F, Alam ABMM, Ivy R, Parveen F (2020) Fertility-sparing Surgery (FSS) in Epithelial Ovarian Cancer (EOC): A Case Report. Bangladesh J Obstet Gynecol 35(1):46\u0026ndash;48\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin W, Cao D, Shi X, You Y, Yang J, Shen K (2022) Oncological and Reproductive Outcomes After Fertility-Sparing Surgery for Stage I Mucinous Ovarian Carcinoma. 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Med (Baltim) 101(17):e29163\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"European University Cyprus","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Fertility preservation, fertility-sparing surgery, ovarian cancer, reproductive outcomes, survival rates","lastPublishedDoi":"10.21203/rs.3.rs-6115489/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6115489/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003e This systematic review evaluates the oncologic and reproductive outcomes of fertility-sparing surgery (FSS) in women diagnosed with stage I ovarian cancer, as classified by the International Federation of Gynecology and Obstetrics (FIGO). The goal is to assess the safety and effectiveness of FSS in preserving fertility without compromising survival outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA systematic search was conducted in MEDLINE (PubMed), SCOPUS, and Google Scholar for studies published in English from 2014 onward. Studies involving women under 50 with stage I ovarian cancer who opted for FSS were included. Data extraction focused on oncologic outcomes (recurrence and survival rates) and reproductive outcomes (pregnancy and live birth rates). Study selection followed PRISMA guidelines.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSeventeen studies comprising 1030 patients met the inclusion criteria. Pregnancy success rates ranged from 25\u0026ndash;91.3%, with live birth rates exceeding 80% in most studies. Spontaneous conception was predominant, though 3.7\u0026ndash;28% of patients required assisted reproductive technologies (ART). Despite 58% of patients expressing a desire for future pregnancy, only 13% actively attempted conception. Recurrence rates varied from 3\u0026ndash;33.3%, with most studies reporting between 8% and 15%. Overall survival ranged from 88\u0026ndash;100%, and disease-free survival remained above 90%. The highest recurrence was observed in mucinous ovarian carcinoma and FIGO Stage IC2/IC3 subtypes.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eFSS in stage I ovarian cancer is a viable alternative to radical surgery in carefully selected patients, with favorable oncologic and reproductive outcomes. However, recurrence risks and fertility challenges highlight the need for multidisciplinary counseling, long-term surveillance, and further research to refine selection criteria and optimize fertility preservation techniques.\u003c/p\u003e","manuscriptTitle":"Fertility Sparing Surgery Upon Reproductive and Oncologic results in Ovarian Cancer patients Stage I (FIGO): A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-28 06:54:07","doi":"10.21203/rs.3.rs-6115489/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ab2acb04-9ec1-4857-abdb-c60a9a32d866","owner":[],"postedDate":"February 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":44924500,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2025-02-28T06:54:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-28 06:54:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6115489","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6115489","identity":"rs-6115489","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}