Impact of ovarian preservation on survival for premenopausal women with early‐stage endometrial carcinoma: A systematic review and meta‐analysis

Objective: Up to 14% of women with early-stage endometrial carcinoma (EEC) are diagnosed before menopause. Although ovarian preservation (OP) within surgical staging might avoid surgical menopause, its rate remains low in clinical practice, probably because the impact of OP on survival outcomes is unclear. This study evaluates the impact of OP on (i) survival outcomes, (ii) adverse events, and (iii) quality of life (QoL) in young women with EEC. Method: A systematic review and meta-analysis was performed searching seven electronic databases from their inception to 2022. The study included all randomized controlled trials (RCTs) and non-randomized comparative studies (NRS) comparing survival outcomes of women who underwent OP versus bilateral salpingo-oophorectomy (BSO). Primary outcome was the risk of death of any cause, while secondary outcomes were the risk of death due to endometrial carcinoma, the risk of recurrent disease, adverse events after ovarian surgery, and QoL. Results: Twelve studies were included in the qualitative synthesis, while nine studies with a total of 115 528 women were suitable for the quantitative analysis. Compared to the BSO group, the OP group had a hazard ratio of 0.805 (95% confidence interval [CI]: 0.655-0.989) for death of any cause, 1.079 (95% CI: 0.395-2.953) for death due to endometrial carcinoma, and 1.332 (95% CI: 0.663-2.674) for recurrent disease. No pooled data were obtainable for adverse events after ovarian surgery and QoL. Conclusion: In young women with EEC, our study seems to support the OP at the time of surgical treatment as it appears to reduce the risk of death of any cause by approximately 20%, with no impact on the risk of death due to endometrial carcinoma and the risk of recurrent disease. However, given the risk of bias of the included studies, further well-designed studies are needed.