Should ovaries be removed or not in (early-stage) adenocarcinoma of the uterine cervix: A review

- Ovarian metastasis in early-stage adenocarcinoma of the cervix is rare.
- Ovarian preservation in early-stage adenocarcinoma of the cervix is safe.
- Bilateral oophorectomy in early-stage adenocarcinoma of the cervix should be reassessed.

ObjectivesThere is considerable controversy regarding the safety of ovarian preservation in adenocarcinoma of the cervix. The aim of this review is to determine the incidence of ovarian metastasis in patients with adenocarcinoma of the cervix (particularly in early-stage disease), identify risk factors for ovarian metastasis and evaluate the outcome of patients with ovarian preservation.MethodsRelevant articles were identified from MEDLINE and EMBASE. Included studies were prospective or retrospective cohort and cross-sectional studies analyzing the incidence of ovarian metastasis in adenocarcinoma of the cervix and studies evaluating the outcome of patients with ovarian preservation.ResultsTen articles including 1204 patients evaluated the frequency of ovarian metastasis. The incidence considering all FIGO stages was 3.7% (range: 0%-12.9%) and the incidence in FIGO stage IB was 2% (range: 0.8%-3.2%).Six articles evaluated the outcome of patients with ovarian preservation. With more than 100 patients with adenocarcinoma of the cervix FIGO stage (CIS-IIA), none developed an ovarian relapse with a mean follow-up time of 56 months.Six articles including 31 patients with ovarian spread were analyzed. At least one of the following risk factor was present in 30/31 (96.7%) of the patients: age > 45, FIGO stage > IB, positive lymph nodes, deep stromal invasion, lympho-vascular space invasion, corpus invasion, parametrial invasion or tumor size > 4 cm.ConclusionOvarian preservation in young women with early-stage adenocarcinoma of the uterine cervix is safe. Herein, we propose a set of selection criteria to properly identify candidates for ovarian preservation.