Feasibility of ovarian preservation in patients with early stage endometrial carcinoma.

OBJECTIVES: Our objective was to determine the frequency of a coexisting ovarian malignancy and to evaluate the feasibility of ovarian preservation in patients with early stage endometrial carcinoma.

METHODS: Endometrial cancer patients who received primary surgical treatment between 1992 and 2004 were identified using the institution's tumor registry. Information regarding patient age, preoperative and intraoperative evaluations, pathologic reports, and follow-up results was abstracted from medical records.

RESULTS: Coexisting ovarian malignancy was detected in 19 (7.31%) of 260 patients who underwent surgical treatment (12 metastatic and 7 synchronous primaries). The independent risk factors of a coexisting ovarian malignancy, as determined using a logistic regression model, were intraoperative extrauterine disease, non-endometrioid histology, lymph node metastasis, and patient age, and the presence of intraoperative extrauterine disease was found to most significantly predict ovarian involvement (OR=542.1; 95% CI, 57.18 to 5139.23). Seventeen of the 19 cases showed abnormal intraoperative gross findings around adnexa or other sites. Among the 206 patients without any evidence of intraoperative extrauterine disease, the coexisting ovarian malignancy rate was 0.97% (2/206), and zero for those under age of 45. In 35 patients, grossly normal ovaries were selectively saved, and no recurrence or cancer-related death occurred (median duration of follow-up: 76 months, range 3-121).

CONCLUSIONS: The risk of coexisting malignancy in patients without predictable risk factors is minimal. Therefore, it is possible to preserve ovaries in young women with early stage endometrial carcinoma with a thorough preoperative evaluation and extensive intraoperative exploration.