Fertility Sparing Surgery and Borderline Ovarian Tumours

Area of Science:

• Gynecologic Oncology
• Reproductive Medicine
• Surgical Oncology

Background:

• Borderline ovarian tumors (BOTs) management requires balancing oncological safety with fertility preservation.
• Fertility-sparing surgery (FSS) is an option for BOTs, but its oncological outcomes compared to non-FSS need clarification.
• Recurrence patterns, including transformation to low-grade serous carcinoma (LGSC), are critical in assessing surgical approaches.

Purpose of the Study:

• To evaluate and compare oncological outcomes between FSS and non-FSS in women with BOTs.
• To analyze recurrence rates and types (BOT vs. LGSC) based on surgical management.
• To assess the impact of a novel FSS technique, ultrasound-guided ovarian wedge resection (UGOWR).

Main Methods:

• Retrospective analysis of 172 women diagnosed with BOTs between 2004-2020 at a specialized center.
• Comparison of recurrence rates and types between FSS (n=90) and non-FSS (n=82) groups.
• Statistical analysis, including Pearson Chi-Square, to determine significant associations between surgery type and recurrence.

Main Results:

• Overall recurrence rate was 16.9%; 79.3% were recurrent BOTs and 20.7% were LGSC.
• FSS group had a BOT recurrence rate of 25.6% with no LGSC recurrences reported.
• Non-FSS group had a 7.7% recurrence rate, exclusively presenting as LGSC. A significant difference in recurrence association was found between FSS and non-FSS (p=0.000).

Conclusions:

• Non-FSS is associated with poorer oncological outcomes, specifically a higher rate of LGSC recurrence, compared to FSS.
• FSS, potentially aided by long-term ultrasound surveillance, may facilitate earlier detection and treatment of recurrences.
• The type of FSS performed did not significantly impact BOT recurrence rates.