Abstract
BackgroundTo compare the postoperative recurrence and fertility in patients with borderline ovarian tumors (BOTs) who underwent different surgical procedures: salpingo-oophorectomy versus cystectomy.MethodsPotentially relevant literature from inception to Nov. 06, 2020, were retrieved in databases including Cochrane Library, EMBASE (Ovid), and MEDLINE (Pubmed). We applied the keywords “fertility-sparing surgery,” or “conservative surgery,” or “cystectomy,” or “salpingo-oophorectomy,” or “oophorectomy,” or “adnexectomy,” or “borderline ovarian tumor” for literate searching. Systemic reviews and meta-analyses were performed on the postoperative recurrence rates and pregnancy rates between patients receiving the two different surgical methods. Begger’s methods, Egger’s methods, and funnel plot were used to evaluate the publication bias.ResultAmong the sixteen eligible studies, the risk of recurrence was evaluated in all studies, and eight studies assessed the postoperative pregnancy rates in the BOT patients. A total of 1839 cases with borderline ovarian tumors were included, in which 697 patients (37.9%) received unilateral salpingo-oophorectomy and 1142 patients (62.1%) underwent unilateral/bilateral cystectomy. Meta-analyses showed that BOT patients with unilateral/bilateral cystectomy had significantly higher recurrence risk (OR=2.02, 95% CI: 1.59-2.57) compared with those receiving unilateral salpingo-oophorectomy. Pooled analysis of four studies further confirmed the higher risk of recurrence in patients with cystectomy (HR=2.00, 95% CI: 1.11-3.58). In addition, no significant difference in postoperative pregnancy rate was found between patients with the two different surgical procedures (OR=0.92, 95% CI: 0.60-1.42).ConclusionCompared with the unilateral/bilateral cystectomy, the unilateral salpingo-oophorectomy significantly reduces the risk of postoperative recurrence in patients with BOT, and it does not reduce the pregnancy of patients after surgery.Trial registrationPROSPERO CRD42021238177
Highlights
Borderline ovarian tumors (BOTs) refer to the tumor of the ovarian with a property between benign and malignant masses, which was first discovered by Tayor in 1929 [1]
A pooled analysis did not reveal a significant difference in the postoperative pregnancy rates between patients underwent unilateral/bilateral cystectomy (OR=0.92, 95% CI: 0.60-1.42, P > 0.05, Fig. 3), suggesting that the two surgical procedures had similar effects on the postoperative fertility in patients with borderline ovarian tumors (BOTs)
No significant publication bias was presented on the funnel plot (Supplementary Figure 4). In this systemic review and meta-analysis, we found that BOT patients with unilateral/bilateral cystectomy were showed a higher risk of relapse compared with those who underwent unilateral salpingo-oophorectomy
Summary
Borderline ovarian tumors (BOTs) refer to the tumor of the ovarian with a property between benign and malignant masses, which was first discovered by Tayor in 1929 [1]. For the treatment of BOT, surgery is the preferred method for patients at early stages though debates are always exited for different procedures [6]. The last few decades witnessed the rapid development of nanotechnology, a promising method for patients with BOT. This strategy applied particles at nano-levels to deliver drugs to the tumors for local treatment. BOTs are more commonly discovered in women at premenopausal status, especially before 40 years old [8, 9]. At this special life stage, many diagnosed women express strong expectation of preserving fertility. To compare the postoperative recurrence and fertility in patients with borderline ovarian tumors (BOTs) who underwent different surgical procedures: salpingo-oophorectomy versus cystectomy
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