Surgical management of borderline ovarian tumors: The role of fertility-sparing surgery

Objective. To evaluate the recurrence, survival, and pregnancy outcomes of patients with borderline ovarian tumors (BOT) treated with fertility-sparing surgery. Methods. The medical records of patients with BOT who underwent surgery between 1989 and 2008 were retrospectively reviewed. Outcomes were compared between groups that underwent radical or fertility-sparing surgery. Fertility-sparing surgery was defined as the preservation of the uterus and ovarian tissue in one or both adnexa. Results. During the study period, 360 patients with BOT were identified; of these, 344 had stage 1, one had stage 11, and 15 had stage III disease. A total of 176 patients underwent radical surgery (23 laparoscopically and 153 laparotomically), and 184 underwent fertility-sparing surgery (48 laparoscopically and 136 laparotomically). After surgery, 45 patients received adjuvant chemotherapy. After a median follow-up time of 70 months (range, 3-216 months), 18 patients had recurrent disease and 5 died of disease. The recurrence rate was Similar in the radical and fertility-sparing surgery groups (4.9% vs. 5.1%, p=0.923). In the fertility-sparing surgery group, however, the most common site of recurrence was the remaining ovarian tissue which was successfully salvaged with a second round of fertility-sparing surgery. Multivariate analysis showed no difference in disease-free survival between groups that underwent radical or fertility-sparing surgery (p=0.651). To date, there have been 34 full-term deliveries by women in the fertility-sparing surgery group. Conclusions. Fertility-sparing Surgery for patients with BOT is safe and can permit future pregnancy, suggesting that such surgery should be considered for young patients who wish to preserve fertility. (C) 2009 Elsevier Inc. All rights reserved.