(O P2) Cytoreductive Surgery, Hyperthermic Intraperitoneal Chemotherapy and Subsequent Fertility: Should We Be Doing More?
Sunday, February 16, 2020
1:25 PM – 1:30 PM
Introduction: Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly accepted as the best therapeutic option in some primary or secondary peritoneal malignancies. The ramifications of this procedure on future pregnancy are unknown and existing literature on this topic is limited. The aim of this study was to determine the effect of CRS/HIPEC on fertility and childbearing feasibility following surgery.
Methods: A retrospective review of patients who underwent CRS/HIPEC between 2009 and 2019 was performed. Female patients were included if they were between ages 18-50 at the time of surgery. Gynecologic history prior to and following CRS/HIPEC was collected by phone interview.
Results: Of 48 eligible participants, 21 completed the survey. The average age at surgery was 41.5years. Eighty six percent of women underwent a total abdominal hysterectomy prior to or during CRS. A majority of patients also underwent unilateral or bilateral oophorectomy (14.3% vs. 47.6%). Twenty nine percent of these women recall fertility counseling prior to CRS/HIPEC, while 14.3% saw a fertility specialist for consultation, and only one patient proceeded with oocyte cryopreservation prior to treatment. There were no pregnancies reported following treatment with CRS/HIPEC.
Conclusions: The full effect of CRS/HIPEC on fertility remains unclear; ascertainment of CRS/HIPEC’s impact on future fertility is compounded by the high rate of hysterectomy and oophorectomy at time of surgery. Future studies evaluating the safety of preserving reproductive organs as well as ovarian reserve before and after surgery are necessary in order to understand the impact of CRS/HIPEC on fertility.