Oncological and reproductive outcomes of cystectomy compared with unilateral salpingo-oophorectomy as fertility-sparing surgery in patients with apparent early-stage pure immature ovarian teratomas

Objectives: To compare the oncological and reproductive outcomes of patients with apparent early-stage pure immature teratomas (IMTs) of the ovary treated with cystectomy or unilateral salpingo-oophorectomy (USO). Methods: We retrospectively reviewed the medical records of patients with apparent early-stage pure IMTs who received fertility-sparing surgery (FSS) between January 1984 and December 2019. FSS was defined as preservation of the uterus and at least one adnexa. Recurrence rates were compared between patients receiving cystectomy and USO. Reproductive outcomes and menstrual histories were assessed by telephone interview. Download : Download high-res image (130KB) Download : Download full-size image Results: A total of 124 patients were included, of whom 41 underwent cystectomy and 83 underwent USO. After a median follow-up of 70.6 months (range: 6.2–410.6 months), eight patients suffered recurrences (3 in the cystectomy group and 5 in the USO group). The median times to recurrence were 5.1 and 5.0 months in the cystectomy and USO groups, respectively (P=0.764). All patients with recurrence were successfully salvaged by surgery, except for one death. Univariate analysis showed no difference in disease-free survival and overall survival between the groups (P=0.781, 0.155). Of the 111 patients contacted by telephone, 97 resumed menstruation following the surgery. Of the 31 patients desiring pregnancy, 26 achieved 28 successful pregnancies. USO (83.3%), like cystectomy (85.7%), resulted in excellent pregnancy rates. Conclusions: A USO is the standard treatment for women with early stage pure IMTs who want to preserve fertility. However, a cystectomy may be a suitable fertility-sparing therapy when a cystectomy is the only surgical option.