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Current practice with operative hysteroscopy for fertility preservation in endometrial cancer and endometrial premalignancies

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Abstract

Purpose

The primary aim was to analyze the current practices on the use of operative hysteroscopy for preserving fertility in patients diagnosed with endometrial cancer and premalignancies. Our secondary objectives included investigating medical therapy and analyzing reported pregnancy-related outcomes subsequent to fertility preservation procedures.

Methods

We performed a semi-systematic literature review on PubMed, employing pertinent terms related to hysteroscopy, fertility preservation, and endometrial cancer and premalignancies. Patients undergoing operative hysteroscopy with or without following medical treatment were included. We adhered to the PRISMA 2020 statement and utilized Covidence software to manage our systematic review. We performed a pooled analysis on various outcomes.

Results

Our final analysis included 15 studies evaluating 458 patients, where 238 (52.0%) were diagnosed with endometrial cancer, and 220 (48.0%) had endometrial premalignancies. With 146 pregnancies in our study, the overall pregnancy rate was 31.9%. Among these, 97 resulted in live births, accounting for 66.4% of the reported pregnancies. In terms of medical treatment, various forms of progestins were reported. Complications or adverse effects related to operative hysteroscopy were not reported in more than half of the studies. Among those studies that did report them, no complications nor adverse effects were documented. After hysteroscopic resection, complete response to medical treatment has been reported in 65.5% of the overall cases.

Conclusion

Our review sheds light on the contemporary landscape of operative hysteroscopy for fertility preservation in endometrial cancer and premalignancies. Future studies should include the integration of molecular classification into fertility-preserving management of endometrial malignancies to offer a more personalized and precise strategy.

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Acknowledgements

The authors would like to thank Koç University—School of Medicine for providing institutional access to Covidence.

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Authors and Affiliations

  1. Department of Global Health, Koç University Graduate School of Health Sciences, Istanbul, Turkey

    Esra Bilir

  2. Department of Gynecologic Oncology, Koc University School of Medicine, Istanbul, Turkey

    Esra Bilir

  3. II Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland

    Joanna Kacperczyk-Bartnik

  4. UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

    Nicolò Bizzarri

  5. Private Gynecologic Oncology Clinic, Istanbul, Turkey

    İlker Kahramanoğlu

Authors
  1. Esra Bilir
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  2. Joanna Kacperczyk-Bartnik
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  3. Nicolò Bizzarri
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  4. İlker Kahramanoğlu
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Contributions

EB: study design, protocol development, data collection and management, data analysis, and manuscript writing. JKB: study design, data collection and management, and manuscript writing. NB: study design, protocol development, critical review of the manuscript. IK: study design, protocol development, critical review of the manuscript, study supervisor.

Corresponding author

Correspondence to Joanna Kacperczyk-Bartnik.

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Bilir, E., Kacperczyk-Bartnik, J., Bizzarri, N. et al. Current practice with operative hysteroscopy for fertility preservation in endometrial cancer and endometrial premalignancies. Arch Gynecol Obstet 309, 2267–2278 (2024). https://doi.org/10.1007/s00404-024-07463-9

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  • DOI: https://doi.org/10.1007/s00404-024-07463-9

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