Fertility-sparing surgery (FS) is a viable option for women with early-stage epithelial ovarian cancer (EOC) desiring fertility preservation. However, its oncological outcomes remain debated.

This retrospective cohort study analysed 135 patients with FIGO (International Federation of Gynaecology and Obstetrics) stage I EOC, operated between 1st January 2011 and 31st December 2020, comparing clinicopathological characteristics and oncologic outcomes between women who underwent FS (n = 26) and comprehensive staging surgery (CS) (n = 109). Continuous variables were compared using a t-test and Mann-Whitney test, while categorical variables were compared using the Chi-Square test. Disease-free and overall survival were plotted using Kaplan–Meier curves and compared using a log-rank test.

During this period, Stage I EOC constituted 13.9% of the patients with EOC who underwent surgery. Patients in the FS group were younger (mean age 28.6 years versus 43 years, p = 0.00), with higher rates of nulliparity (77% versus 15%, p = 0.00). Though the pathological profile of the tumours in both groups was similar, 12(46%) in the FS group had high-grade histology. The FS group had a poorer follow-up rate (70% versus 83%, p = 0.033), a higher recurrence rate (30% vs. 8%, p = 0.001), and shorter mean disease-free survival (84.78 months vs. 124.86 months, p = 0.002). Older age and FS were significant predictors of recurrence at 2 and 5 years.

This study suggests that FS may be associated with higher recurrence rates in early-stage EOC. Careful patient selection, precise surgical information, and thorough follow-up protocols are crucial to balancing oncological safety with reproductive goals.