Giorgio Candotti, Vittoria Spotorno, Alice Bergamini, Luca Bocciolone, Raffaella Cioffi, Marianna Di Filippo, Giorgia Mangili, Elisa Grassi, Emanuela Rabaiotti, Giacomo Pavone, Francesca Maria Vasta, Massimo Candiani
In early-stage epithelial ovarian cancer, uterine preservation was associated with reduced blood loss and shorter operative time, possibly reflecting more frequent laparotomy in the hysterectomy group. Recurrence and progression-free survival did not differ, but the few events warrant confirmation in prospective multicentre studies.
PURPOSE: To assess whether hysterectomy improves oncological outcome in patients with early-stage epithelial ovarian cancer and whether uterine preservation offers perioperative advantages.
METHODS: This retrospective cohort study included patients with FIGO stage I-IIA epithelial ovarian cancer treated at a tertiary referral centre between January 2009 and December 2025. Perioperative outcomes, recurrence, and progression-free survival were compared between patients undergoing hysterectomy and those managed with uterine preservation. Multivariable analyses and propensity score matching addressed potential confounding.
RESULTS: Among 152 patients, 119 underwent hysterectomy and 33 underwent uterine-preserving surgery, including 15 who received fertility-sparing surgery. Median follow-up was 52 months. Uterine preservation was associated with lower blood loss, shorter operative time, and shorter hospital stay. After adjustment, hysterectomy remained associated with greater blood loss (+96.8 mL, p = 0.006) and longer operative time (+42.4 min, p < 0.001), but not with postoperative complications or length of hospital stay. Recurrence occurred in 2 patients after uterine preservation and in 20 after hysterectomy (6.1% vs 16.8%, p = 0.164). Uterine preservation was not independently associated with recurrence, and progression-free survival did not differ between groups (log-rank p = 0.182). Findings remained comparable after propensity score matching. Histologically confirmed uterine involvement was identified in 2 of 119 hysterectomy specimens (1.7%).
CONCLUSION: In early-stage epithelial ovarian cancer, uterine preservation was associated with reduced blood loss and shorter operative time, possibly reflecting more frequent laparotomy in the hysterectomy group. Recurrence and progression-free survival did not differ, but the few events warrant confirmation in prospective multicentre studies.