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Conservative surgery for borderline ovarian tumors--emphasis on fertility preservation. A review
N Koutlaki1, M Dimitraki, S Zervoudis
1Department of Obstetrics and Gynecology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece. nikoleta_koutlaki@yahoo.gr
Background:
Borderline ovarian tumors account for 15-20% of all ovarian epithelial tumors. Since their original description in 1929, our knowledge of their natural history and molecular pathology has advanced most dramatically over the last two decades. This improved knowledge of BOT has permitted to drastically decrease the therapeutics of these tumors, which remains mostly surgical.
Method:
We studied the available literature on surgical management of BOT accentuating the most important aspects on this topic: radical vs. conservative treatment, fertility preservation.
Results:
Although there are conflicting reports about some of the aspects of surgical management of these tumors, since BOTs commonly affect women of reproductive age, who have not completed childbearing, have an excellent overall prognosis and the majority of them (approximately 50% to 85%) are stage I at diagnosis, conservative surgery (unilateral salpingo-oophorectomy or cystectomy) can be safely performed after comprehensive surgical staging, in order to preserve fertility.
Conclusion:
Conservative surgery could be safely performed in young patients treated for BOT, provided that they are carefully followed-up.
Insights
Fertility-sparing conservative surgery is safe for borderline ovarian tumors (BOTs) in women desiring future childbearing. Careful follow-up is essential for successful outcomes in these young patients.
Area of Science:
- Gynecologic Oncology
- Reproductive Medicine
- Surgical Pathology
Background:
- Borderline ovarian tumors (BOTs) constitute 15-20% of epithelial ovarian tumors.
- Significant advancements in understanding BOT natural history and molecular pathology occurred in the last two decades.
- Therapeutic strategies for BOTs have been refined, primarily focusing on surgical interventions.
Purpose of the Study:
- To review the literature on surgical management of BOTs.
- To emphasize key aspects of radical versus conservative treatment and fertility preservation.
Main Methods:
- Literature review of available studies on surgical management of BOTs.
- Focus on comparative analysis of radical and conservative approaches.
- Evaluation of fertility preservation strategies.
Main Results:
- Conservative surgery, including unilateral salpingo-oophorectomy or cystectomy, can be safely performed with comprehensive surgical staging.
- Approximately 50-85% of BOTs are diagnosed at Stage I.
- BOTs predominantly affect women of reproductive age, often before completion of childbearing.
Conclusions:
- Conservative surgical approaches are safe for young patients diagnosed with BOTs.
- Careful and consistent follow-up is crucial for patients undergoing conservative surgery.
- Fertility preservation is achievable in select cases of borderline ovarian tumors.
