Objective: To evaluate the impact of ovarian preservation on overall survival in young women with early-stage endometrial cancer. Design: Retrospective and meta-analysis. Setting: Two medical centers. Patient(s): A total of 203 patients diagnosed with endometrial cancer (<= 45 years) from 2000 until 2010. Intervention(s): Patients who underwent oophorectomy versus those whose ovaries were preserved. Main Outcome Measure(s): The overall survivals were compared. Independent factors that may affect the patients' survival were extracted and analyzed. A meta-analysis of the literature was carried out to further validate the findings. Result(s): Of 203 young patients, 169 patients (83.3%) underwent bilateral salpingo-oophorectomy, 20 patients had both ovaries preserved, and 14 patients had a single ovary preserved. Multivariate logistic regression identified intraoperative extrauterine disease as the most significant risk factor of ovarian involvement. A Kaplan-Meier curve and Cox proportional hazards models analyses found that ovarian preservation had no effect on overall survival. The findings were validated by meta-analysis. Conclusion(s): Ovarian preservation has no statistically significant impact on the overall survival of young patients with early-stage endometrial cancer. The ovaries should be preserved in this specific population after a thorough preoperative evaluation and an extensive intraoperative exploration. ((C) 2013 by American Society for Reproductive Medicine.)