-Original-

Oncologic Outcomes of Fertility-Sparing Surgery versus Radical Surgery for Stage I Epithelial Ovarian Cancer

Yumene Kubota¹, Masafumi Toyoshima², Akiko Sakata², Mariko Ikeda², Akihito Yamamoto², Rieko Kawase³, Keisuke Kurose⁴ and Shunji Suzuki²

¹Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
²Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
³Department of Obstetrics and Gynecology, Kawakita General Hospital, Tokyo, Japan
⁴KUBONOYA Women's Hospital, Chiba, Japan

Background: Epithelial ovarian cancer (EOC) is increasingly affecting women of reproductive age. Fertility-sparing surgery (FSS) is an option for patients with early EOC who want to preserve their fertility, but the oncologic safety of FSS requires rigorous evaluation. This study retrospectively compared the oncologic outcomes of FSS with those of radical surgery (non-FSS) for patients with FIGO 2014 Stage I EOC at our institution.
Methods: We retrospectively reviewed the medical records of patients younger than 45 years diagnosed with FIGO 2014 Stage I EOC (April 2010-June 2024). Patients were categorized into FSS (n=11) and non-FSS (n=9) groups. Baseline characteristics, recurrence rates, progression-free survival (PFS), and overall survival (OS) were compared.
Results: Twenty patients were included. The FSS group was significantly younger (median age 29.2 vs 40.8 years, p=0.043). Recurrence was more frequent in the FSS group (36.4% vs 11.1%), although this difference was not significant (p=0.077). Kaplan-Meier analysis showed no significant difference in PFS (HR 3.24, 95% CI: 0.56-18.74, p=0.19) or OS (HR 1.78, 95% CI: 0.18-16.9, p=0.63).
Conclusion: In this small cohort, FSS for Stage I EOC yielded a higher recurrence rate, but no significant difference in survival, as compared with radical surgery. Because of the small size and inherent stage-migration bias from incomplete surgical staging in the FSS group, these findings should be interpreted with extreme caution. Careful patient selection, thorough staging, and strict surveillance are crucial when implementing FSS.

J Nippon Med Sch 2026; 93: 72-79

Keywords
epithelial ovarian cancer, fertility-sparing surgery, stage I, oncologic outcomes

Correspondence to
Masafumi Toyoshima
m-toyoshima@nms.ac.jp

Received, April 15, 2025
Accepted, November 12, 2025