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

Esra Bilir; Joanna Kacperczyk-Bartnik; Nicolò Bizzarri; İlker Kahramanoğlu

doi:10.1007/s00404-024-07463-9

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

Arch Gynecol Obstet. 2024 Mar 17. doi: 10.1007/s00404-024-07463-9. Online ahead of print.

Authors

Esra Bilir^{1

2}, Joanna Kacperczyk-Bartnik³, Nicolò Bizzarri⁴, İlker Kahramanoğlu⁵

Affiliations

¹ Department of Global Health, Koç University Graduate School of Health Sciences, Istanbul, Turkey.
² Department of Gynecologic Oncology, Koc University School of Medicine, Istanbul, Turkey.
³ II Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland. asiakacperczyk@gmail.com.
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.
⁵ Private Gynecologic Oncology Clinic, Istanbul, Turkey.

PMID: 38493419
DOI: 10.1007/s00404-024-07463-9

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.

Keywords: Atypical endometrial hyperplasia; Endometrial cancer; Fertility preservation; Operative hysteroscopy; Pregnancy.

Publication types

Review