Is it possible to preserve the ovaries during surgical intervention in younger women diagnosed with endometrial cancer?

Lau et al. authored a valuable article entitled “Impact of ovarian preservation in women with endometrial cancer”. This retrospective cohort study enrolled 529 patients with endometrial cancer between 2000 and 2010. Among these, 17 were in the ovarian preservation group and 517 in the bilateral salpingo-oophorectomy (BSO) group. The authors investigated the impact of ovarian preservation on the outcome of patients with endometrial cancer. We recognize the probity of this publication. The relationship between hormones and endometrial cancer is well-known because disease states, such as chronic anovulation and endogenous estrogen production from hormonesecreting organ or tumors, are related to excess estrogen, and unopposed estrogen use might lead to endometrial overgrowth, hyperplasia, and subsequent development of endometrial cancer. Since the concern regarding ovarian preservation is that continued ovarian estrogen production might increase the risk of endometrial cancer recurrence, preservation of the ovariesda main organ producing estrogen, and of course progesteronedin patients with endometrial cancer is the biggest challenge and unresolved issue that is worthy of further discussion. The standard treatment for endometrial cancers is a complete and thorough staging surgery, including washing cytology, total hysterectomy (TH), BSO, retroperitoneal lymph node sampling or dissection and randomized biopsy for any suspicious lesion. BSO is typically performed in conjunction with TH to exclude occult ovarian metastases and to decrease estrogen production, which might be beneficial in type I endometrioid cancer therapy. Despite the theoretical benefits of BSO during endometrial cancer treatment, this procedure results in surgical menopause with the subsequently increasing risk of long-term sequelae of estrogen deprivation, such as cardiovascular disease or osteoporosis. By contrast, ovarian preservation may lead to the potentially fatal risk of overlooking occult ovarian metastases and coexisting synchronous ovarian primary tumors and the potential risk of endocrine stimulation of residual microscopic endometrial cancers. Therefore, how to balance the benefit and risk ratio might be a big challenge. The following will be focused on rationale and evidence of the use of ovarian preservation in the management women with endometrial cancer.