Ovarian borderline tumors and minimally invasive surgery: a narrative review

Borderline ovarian tumors (BOTs) are a distinct subgroup of epithelial ovarian neoplasms that commonly affect women of reproductive age and are associated with excellent overall survival. Management is primarily surgical and requires balancing oncologic considerations with fertility preservation. This narrative review summarizes current evidence regarding pathology, molecular features, surgical management, recurrence patterns, and emerging future directions in BOT care, with a focus on minimally invasive surgery (MIS). Recent observational studies suggest that MIS may offer significant perioperative benefits, including reduced blood loss, shorter hospital stay, and faster recovery, while demonstrating apparently comparable recurrence and survival outcomes in appropriately selected patients. However, the available evidence is predominantly retrospective and subject to selection bias and other limitations; therefore, definitive conclusions regarding the oncologic safety or equivalence of MIS cannot yet be made. Fertility-sparing surgery remains an important option for younger women, although it is associated with higher recurrence rates compared with radical surgery. Prognosis is largely influenced by established clinicopathologic factors such as stage, histologic subtype, invasive implants, and completeness of staging rather than surgical approach alone. Emerging advances in molecular profiling, artificial intelligence, and liquid biopsy may further improve risk stratification and personalized management. Overall, current observational data suggests that minimally invasive and fertility-preserving approaches may be appropriate in carefully selected patients, with potential perioperative advantages and apparently comparable oncologic outcomes. Nevertheless, the low level of evidence and predominantly retrospective nature of the available literature preclude definitive conclusions regarding oncologic safety, and further prospective studies with long-term follow-up are needed to define optimal management strategies.