Management Of Borderline Ovarian Tumors Research Articles

Laparoscopic Fertility-Sparing Management of Borderline Ovarian Tumors: Surgical and Long-Term Oncological Outcomes.

Objectives: To assess the long-term oncological safety of laparoscopic fertility-sparing surgery (FSS) in borderline ovarian tumors and the impact of laparoscopic surgical factors on recurrences. Primary outcomes were the recurrence rate and time to recurrence after laparoscopic FSS. Secondary outcomes were to evaluate the recurrence rate after a second laparoscopic surgery and to assess factors associated with the risk of relapse. Methods: This is a retrospective single-center observational study in a tertiary university-affiliated hospital. Thirty-four patients diagnosed with borderline ovarian tumors who underwent laparoscopic FSS were recruited. Patients were categorized into two groups: the adnexectomy group, including patients who underwent unilateral adnexectomy, and the cystectomy group, which included patients who underwent unilateral cystectomy, bilateral cystectomy, and unilateral adnexectomy with contralateral cystectomy. Results: Eleven relapses (32.3%) were observed during a median follow-up period of 116.1 [62.5-185.4] months. The recurrence rate was similar for patients who underwent cystectomy (6/19, 31.6%) and adnexectomy (5/15, 33.3%). Cystectomy led to a shorter time to first recurrence (36-month progression-free survival rates of 66% vs. 85%) and higher rates of capsular rupture (71.4% vs. 20%, p = 0.04) compared to adnexectomy. No deaths due to progression of disease were reported. Conclusions: Laparoscopic FSS for borderline ovarian tumors is a safe, long-term oncological option. Although the recurrence rate was similar in patients undergoing adnexectomy or cystectomy, the time to recurrence was shorter in cases treated with cystectomy. Further research is needed to identify eventual laparoscopic risk factors more strongly correlated with recurrence.

Diagnosis and Management of Borderline Ovarian Tumors: A Case Report

Diagnosis and Management of Borderline Ovarian Tumors: A Case Report

Management of borderline ovarian tumors: A retrospective study in Northern Greece

Introduction: Borderline ovarian tumors (BOTs) are tumors of low malignant potential commonly presented in women of reproductive age. Their incidence has been increasing over the years and issues regarding fertility preservation are very crucial. Material and methods: This was a retrospective cohort study including all cases of BOTs diagnosed and surgically treated, during a 12-year period (2010 – 2022) at the Third Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Greece. Student’s t-test and Mann-Whitney tests were used to compare age, parity, serum Ca-125 and maximum dimensions of the tumors between the patients treated radically and those treated conservatively. The Fisher’s exact test was used to compare categorical variables between the groups with radical versus conservative surgery. Results: In total, 34 cases were managed during the study period with a median follow-up of 114.5 months. The mean age was 50 years, the median parity was 2, the median of Ca-125 was 20.6 U/ml and the median of the maximum dimensions of the tumors was 10 cm. Laparotomy was performed in 82.4% of the cases. In 29.4% of cases, the BOT was bilateral. There was no case with residual disease, the majority were serous tumors at stage I. The mean age (53.9 vs 32.2, p-value<0.001), the median parity (2 vs 1, p-value=0.009) and the median serum Ca-125 (21.1 vs 13, p-value=0.046) were significantly higher in women who underwent radical surgery than those with conservative surgery. The recurrence rate was 2.9%. Conclusion: A favorable long-term prognosis was observed in women diagnosed with BOTs, without any tumor-related deaths. Conservative surgery for fertility preservation may appear as beneficial.

Management of Borderline Ovarian Tumours: Tertiary Centre Experience from Turkey.

This study aimed to analyse the management protocols, surgical approaches, and outcomes of the women with Borderline ovarian tumours (BOT) at Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey. One hundred and seventy-seven patients diagnosed with serous and mucinous BOT were enrolled in the study. Demographic, clinical, and pathological data were reviewed retrospectively from the medical records. The patients were divided into two groups according to surgical interventions: Laparoscopy group (n=50) and Laparotomy group (n=127). Treatment was conservative in 107 (60.5%) patients. Mean age at diagnosis (48.69 ± 12.52 vs. 41.1±11.66 years, p<0.001), tumour size (84.13 ± 51.85 mm vs. 67.1 ± 34.78 mm, p = 0.013), and number of postmenopausal patients (n = 55 vs. 9, p = 0.002) were significantly higher in the Laparotomy group. There were no significant differences in the rates of intraoperative cyst rupture (22% vs. 18%, p = 0.120) and recurrence (2.25% vs. 5.05%, p = 0.760). There was no difference between radical vs. conservative surgery and laparotomy vs. laparoscopy in terms of recurrences. In appropriate cases, the conservative treatment and laparoscopy may be preferred. Key Words: Borderline ovarian tumour, Laparoscopy, Laparotomy.

The impact of adjuvant antihormonal therapy versus observation on recurrence of borderline ovarian tumors: A retrospective cohort study

ObjectivesAdjuvant management of borderline ovarian tumors (BOT) after surgical diagnosis and staging is not standardized. While many patients undergo observation alone, some providers have introduced the use of adjuvant antihormonal therapy for BOT, extrapolating from studies suggesting improvement in progression-free survival in the low-grade serous ovarian carcinoma population. We hypothesized that adjuvant antihormonal therapy after surgical diagnosis of BOT would improve progression-free survival compared to surveillance alone. MethodsThis is a retrospective review of BOT at one academic institution over thirteen years comparing management with antihormonal therapy, including aromatase inhibitors, progestins, and selective estrogen receptor modulators, to surveillance alone. Patients with concurrent malignancy were excluded. Data were abstracted from electronic medical records. Groups were compared by bivariate statistics. ResultsWe identified 193 patients with BOT. Of these, 17 (8.8%) were treated with adjuvant antihormonal therapy and 24 (12.4%) recurred. Patients treated with antihormonal therapy were more likely to be obese (64.7% vs 37.9%, p = 0.032), have advanced-stage disease (70.6% vs 11.4%, p < 0.001), serous histotype (94.1% vs 59.4%, p = 0.005) or microinvasion (29.4% vs 9.7%, p = 0.030), and less likely to have undergone fertility-sparing surgery (18.8% vs 51.7%, p = 0.012). Use of antihormonal therapy was not associated with a difference in recurrence or survival. ConclusionsThis study is the first retrospective cohort review of adjuvant antihormonal therapy in BOT. We found that adjuvant antihormonal therapy for BOT is not associated with recurrence. While this single institution retrospective cohort study may lack the power to confirm or refute benefit, further studies could evaluate whether a subpopulation exists in whom antihormonal therapy is worthwhile.

Management of Borderline ovarian tumors (BOT): results of a retrospective, single center study in Switzerland

BackgroundBorderline tumors are malignant epithelial ovarian tumors with a very low incidence. Thus experience in diagnostics and treatment is still rare. The aim of this study was to present and analyze data of women with borderline ovarian tumor (BOT) regarding clinical features, histological characteristics, diagnostics and treatment management.MethodsIn this single center retrospective study women with BOT treated at the Departement of Gynecology and Obstetrics at the Kantonsspital Luzern between 2011 and 2018 were analyzed according to their clinical and histological reports.ResultsA total of 42 women were enrolled. The median age was 58.5 with a range from 26 to 85, of which 31 (73.8%) were postmenopausal. Regarding the histological subtypes, 23 women (54.8%) had serous and 15 (35.7%) had mucinous BOT. Seromucinous histology was found in 3 patients (7.1%) and endometrioid in 1 woman (2.4%), respectively. All women underwent surgery. In a total of 39 women (92.9%) a complete surgical staging for BOT was performed. In 29 women (69.0%) staging was performed by laparoscopy, 13 (31.0%) underwent laparotomy. The mean follow up was 52 months (range = 16.3–101.4 months). During this period two patients, initially diagnosed in FIGO stage 1, recurred after 21.7 and 44 months, respectively, the second woman died after 53 months because of the BOT.ConclusionIn the present study women were treated according to the international therapy recommendations and the rate of recurrence was very low. The most common risk factors for relapse are known to be FIGO stage, incomplete staging and peritoneal implants but were not present in our group. Thus further studies are necessary to investigate additional recurrence risks.

Management of borderline ovarian tumors: A tertiary referral center experience in Egypt.

BackgroundIn this retrospective study, we discuss our experience as a large tertiary referral center in Egypt in the management and follow-up of borderline tumorsPatients and methodsThis is a retrospective cohort study where all patients diagnosed with a borderline ovarian tumor at Oncology Center Mansoura University from November 2014 to June 2020 were included. Demographics, preoperative, operative, postoperative, pathologic, and oncologic follow-up data were retrieved from a prospectively maintained electronic database. The included patients were followed until April 2022.ResultsWe included 27 patients with borderline ovarian tumors. The mean age of the study patients was 47.67 ± 16.39 years. The median CA 125 was 33 (6–304 U/ml). Frozen section examination was utilized in 13 patients (48.14%), where a diagnosis of borderline ovarian tumors was revealed in 8 patients. Recurrence was reported in one patient with serous type after approximately 26 months. The most common pathological type in our cohort was the mucinous borderline type reported in 14 patients (51.9%), followed by the serous type reported in 11 patients (40.7%), and the seromucinous type in 1 patient only. Patients with mucinous borderline type were significantly younger (40.083 ± 18.47 vs. 53.73 ± 11.91 years, p = 0.028). Interestingly, Cancer Antigen 125 levels were significantly higher in mucinous than serous and seromucinous types [67(16–304) vs. 20(6–294.6) U/ml, p = 0.027]. On the other hand, the radiological tumor size of serous and seromucinous types was larger than that of the mucinous type [23(19–31) cm vs. 8(5–20) cm, p = 0.001]. Over a median follow-up period of 58.66 (54.16–63.16) months, only one postoperative mortality was reported, while only one recurrence was reported.ConclusionBorderline ovarian tumors still represent a dilemma either in diagnosis or management. A frozen section examination could help to reach a preliminary diagnosis. Total abdominal hysterectomy and bilateral salpingo-oophorectomy are the cornerstone of surgical management; however, fertility-sparing surgery could be a valid option for women desiring fertility.

The challenging management of borderline ovarian tumors (BOTs) in women of childbearing age.

Borderline ovarian tumors (BOTs) account for approximately 15% of all epithelial ovarian cancers. In 80% of cases the diagnosis of BOTs is done at stage I and more than a third of BOTs occurs in women younger than 40 years of age wishing to preserve their childbearing potential; the issue of conservative surgical management (fertility-sparing treatment) is thus becoming of paramount importance. At early stages, the modalities of conservative treatment could range from mono-lateral cystectomy to bilateral salpingo-oophorectomy. Although cystectomy is the preferred method to promote fertility it can lead to an elevated risk of recurrence; therefore, an appropriate counseling about the risk of relapse is mandatory before opting for this treatment. Nevertheless, relapses are often benign and can be treated by repeated conservative surgery. Besides the stage of the disease, histological subtype is another essential factor when considering the proper procedure: as most mucinous BOTs (mBOTs) are more commonly unilateral, the risk of an invasive recurrence seems to be higher, compared to serous histotype, therefore unilateral salpingo-oophorectomy is recommended. In the appraisal of current literature, this review aims to gain better insight on the current recommendations to identify the right balance between an accurate staging and an optimal fertility outcome.

Fertility Sparing Surgery and Borderline Ovarian Tumours

Simple SummaryFertility-sparing surgery (FSS) is now a widely acceptable treatment for the management of Borderline Ovarian Tumours (BOTs) in women of reproductive age. However, many clinicians face the dilemma of balancing the risks of disease recurrence with progression to lethal malignancy whilst preserving fertility, in the absence of clear standardized guidelines. The aim of this study was to evaluate the oncological outcomes in women who underwent FSS for the management of primary, or recurrent presentation of BOTs, to provide clinicians with further evidence of the safety and feasibility of FSS. Oncological outcomes following a novel method of FSS in the form of laparoscopic ultrasound guided ovarian wedge resection has also been introduced, which has the potential to change the way BOTs are managed in the future in women of reproductive age.To determine the oncological outcomes following fertility-sparing surgery (FSS) for the management of Borderline Ovarian Tumours (BOTs). A retrospective analysis of participants diagnosed with BOTs between January 2004 and December 2020 at the West London Gynaecological Oncology Centre was conducted. A total of 172 women were diagnosed; 52.3% (90/172) underwent FSS and 47.7% (82/172) non-FSS. The overall recurrence rate of disease was 16.9% (29/172), of which 79.3% (23/29) presented as the recurrence of serous or sero-mucinous BOTs and 20.7% (6/29) as low-grade serous carcinoma (LGSC). In the FSS group, the recurrence rate of BOTs was 25.6% (23/90) presenting a median 44.0 (interquartile range (IQR) 41.5) months, of which there were no episodes of recurrence presenting as LGSC reported. In the non-FSS group, all recurrences of disease presented as LGSC, with a rate of 7.7% (6/78), following a median of 47.5 months (IQR 47.8). A significant difference between the type of surgery performed (FSS v Non-FSS) and the association with recurrence of BOT was observed (Pearson Chi-Square: p = 0.000; x = 20.613). Twelve women underwent ultrasound-guided ovarian wedge resection (UGOWR) as a novel method of FSS. Recurrence of BOT was not significantly associated with the type of FSS performed (Pearson Chi- Square: x = 3.166, p = 0.379). Non-FSS is associated with negative oncological outcomes compared to FSS, as evidenced by the higher rate of recurrence of LGSC. This may be attributed to the indefinite long-term follow up with ultrasound surveillance all FSS women undergo, enabling earlier detection and treatment of recurrences.

Status of Surgical Management of Borderline Ovarian Tumors in France: are Recommendations Being Followed? Multicentric French Study by the FRANCOGYN Group

BackgroundBorderline ovarian tumors (BOTs) are tumors with a favorable prognosis but whose management by consensus is essential to limit the risk of invasive recurrence. This study aimed to conduct an inventory of surgical practices for BOT in France and to evaluate the conformity of the treatment according to the current French guidelines.MethodsThis retrospective, multicenter cohort study included nine referral centers of France between January 2001 and December 2018. It analyzed all patients with serous and mucinous BOT who had undergone surgery. A peritoneal staging in accordance with the recommendations was defined by performance of a peritoneal cytology, an omentectomy, and at least one peritoneal biopsy.ResultsThe study included 332 patients. A laparoscopy was performed in 79.5% of the cases. Treatment was conservative in 31.9% of the cases. The recurrence rate was significantly increased after conservative treatment (17.3% vs 3.1%; p < 0.001). Peritoneal cytology was performed for 95.5%, omentectomy for 83.1%, and at least one biopsy for 82.2% of the patients. The overall recurrence rate was 7.8%, and the recurrence was invasive in 1.2% of the cases. No link was found between the recurrence rate and the conformity of peritoneal staging. The overall rate of staging noncompliance was 22.9%.ConclusionThe current standards for BOT management seem to be well applied.

Primary and recurrent serous borderline tumors during pregnancy: a case report and literature review.

The diagnosis and management of borderline ovarian tumors during pregnancy are still not standardized, because these tumors are rarely encountered. We report the case of a 27-year-old pregnant woman who presented with an ovarian mass in her first trimester. Magnetic resonance imaging revealed a multilocular cystic component with papillary lesions in the background of endometriosis, suggesting a seromucinous borderline tumor or ovarian cancer. A right salpingo-oophorectomy and partial omentectomy were performed at 7weeks of gestation. Pathological examination demonstrated a serous borderline tumor. The subsequent pregnancy course was uneventful, and she gave birth to a healthy baby at 39weeks of gestation. She wanted to retain fertility, and close follow-up was performed. Four years later, she became pregnant, and a lesion suggesting recurrence in the left ovary was detected. An abdominal left ovarian cystectomy was performed at 13weeks of gestation, which demonstrated recurrence of the serous borderline tumor. She gave birth to a healthy baby at 39weeks of gestation. Two months after delivery, she underwent total abdominal hysterectomy with left salpingo-oophorectomy, which revealed no malignant findings. We also reviewed 10 reports that included 58 cases of borderline ovarian tumors diagnosed during pregnancy. The borderline ovarian tumors diagnosed during pregnancy exhibited different characteristics according to each subtype, suggesting the importance of diagnosing borderline ovarian tumor subtypes preoperatively.

Management of Borderline Ovarian Tumors: Series of Case Report and Review of the Literature

Borderline ovarian tumors represent a heterogeneous group of tumors with a specific noninvasive histology, a low malignant potential, and an uncertain outcome. They have a low incidence, occurring at younger age and diagnosed in early stages, and are associated with infertility, and they have a better prognosis when compared with epithelial ovarian cancer. We retrospectively evaluated all the patients with the diagnosis of borderline ovarian tumors who underwent surgical treatment between January 1, 2013, and December 31, 2016, in Filantropia Clinical Hospital. In the study, were included 50 patients with borderline ovarian tumors with an average age of 52. Thirty-four patients (68%) were postmenopausal and 16 (32%) were premenopausal. We found 44 unilateral tumors (88%) and 6 bilateral (12%), and the size varied between 3 and 40 cm. Regarding the histopathological examination, we found 34 patients with borderline ovarian tumors of serous type (68%), 12 of mucinous type (24%), and 4 (8%) other types. We had 2 cases of extraovarian extension, one to peritoneal surface and one to the appendix. Surgical treatment was radical in 38 cases and conservative in 12 cases. The management of borderline ovarian tumors should first consider the oncologic safety but will be well balanced with less radical treatment in selected cases. The various clinical and histological aspects of BOT should guide the surgeon and the oncologist to take the best decisions for the patient in order to be as radical as it is necessary.

OC12.02: Management of borderline ovarian tumours: overall survival and long‐term follow‐up

OC12.02: Management of borderline ovarian tumours: overall survival and long‐term follow‐up

Characterization and Management of Borderline Ovarian Tumors – Results of a Retrospective, Single-center Study of Patients Treated at the Department of Gynecology and Obstetrics of the University Medicine Greifswald

Borderline ovarian tumors (BOT) are malignant epithelial ovarian tumors with a very low incidence, therefore lacking sufficient clinical experience in diagnostics and treatment. This study characterized the histology, clinical features, diagnostics and therapy of BOT including patients treated at the Department of Gynecology and Obstetrics of the University Medicine Greifswald. In this retrospective, single-center study, patients with BOT treated between 1990 and 2010 were analyzed according to their histological and clinical reports. A total of 54 patients were enrolled. The median age was 54.6 (range=23-83) years. Distribution of histological subtypes was: serous in 31 patients (57.4 %) and mucinous in 23 patients (42.6%). All patients underwent surgery. Eight patients (14.8%) were treated according to actual therapy recommendations during the initial surgery. Eight patients (14.8%) received adjuvant chemotherapy contrary to treatment recommendations. In the case of 36 patients (66.7%), a frozen section was taken intraoperatively, which matched the definitive histological result in 88.9%. During average follow-up of 70.3 months (range=0-231 months), two patients (3.7%) developed tumor recurrence after 9 and 29 months, respectively, two patients (3.7%) died of causes other than BOT. Our study critically demonstrated that until a few years ago, BOTs were not usually treated according to international therapy recommendations. Nevertheless, the rate of tumor recurrence was very low.

Management of Borderline Ovarian Tumors

Management of Borderline Ovarian Tumors

Management of Borderline Ovarian Tumors-Still a Gray Zone.

Borderline ovarian tumors (BOTs) are a heterogeneous group of non-invasive epithelial ovarian tumors that occur at a younger age, present in early stage, frequently associated with infertility but are easily curable. Although they may have symptomatic long-term recurrences, they have an excellent prognosis in spite of peritoneal spread. Among the epithelial tumors of the ovary, BOTs fall in the spectrum lying between cystadenomas (benign) and cystadenocarcinomas (malignant). Their oncological behavior is more aggressive than benign ovarian tumors but relatively less than that of malignant ovarian tumors. Since the age group affected is usually young females, preservation of fertility is an important aspect of treatment protocol. Although the management of these tumors has been extensively discussed, it still remains a controversial gray zone. In this review, epidemiology, pathogenesis, histologic subtypes, various surgical approaches, follow-up, and management of recurrence have been discussed. Choosing the best treatment still poses a challenge for the treating oncosurgeon.

Identification of factors that impact recurrence in patients with borderline ovarian tumors

BackgroundThe lack of consensus around best practices for management of borderline ovarian tumors (BOT) is, in part, to the lack of available data and of clarity in interpreting relationships among various factors that impact outcomes. The objective of this study was to identify clinicopathological factors that impact prognosis of patients with borderline ovarian tumors (BOT) and to address features of this disease with the objective of providing clarity in decision making around management of BOT.ResultsA total of 178 BOT patients were included in this study, with a median age of 43 years and a median follow-up time of 37 months. Thirty-two (18.0%) recurrences and 5 (2.8%) deaths were observed in this study group. Multivariate analysis showed that fertility-preserving surgery (P = 0.0223 for bilateral cystectomy) and invasive implants (P = 0.0030) were significantly associated with worse PFS, whereas lymphadenectomy (P = 0.0129) was related to improved PFS. No factors were found to be associated with OS due to the limited number of deaths. In addition, patients with serous BOT more commonly had abnormal levels of CA125, while patients with mucinous BOT more commonly had abnormal levels of CEA. Patients with abnormal levels of CA125, or CA19-9, or HE4 had significantly larger tumor sizes.ConclusionsOur study reveals the impact of certain types of fertility-preserving surgery, lymphadenectomy and invasive implants on PFS of BOT patients. Blood cancer markers may be associated with histology and size of BOT. Our findings may assist in selection of optimum treatment for BOT patients.

Diagnosis and Management of Borderline Ovarian Tumor Based on the Iranian Guidelines

Diagnosis and Management of Borderline Ovarian Tumor Based on the Iranian Guidelines

Diagnosis and Management of Borderline Ovarian Tumor Based on the Iranian Guidelines

Diagnosis and Management of Borderline Ovarian Tumor Based on the Iranian Guidelines

術後卵巣境界悪性腫瘍と判明し、腹腔鏡下手術による妊孕性温存手術と surgical stagingを施行した5例の検討

Objectives: Clinical management of borderline ovarian tumors (BOTs) during reproductive age has shifted from radical surgery to fertility-sparing surgery. The aim of this study was to evaluate the feasibility of the laparoscopic approach for fertility-sparing surgery for BOTs. Methods: From August 2012 through March 2014, laparoscopic surgery for ovarian tumors was performed for 557 cases, and a total of 11 cases were diagnosed as BOTs. Six patients were premenopausal, and five selected fertility-sparing surgery. We retrospectively reviewed the clinical and surgical parameters of undergoing laparoscopic surgery for reproductive-age women with BOTs at our institution. Results: Four cases had mucinous BOTs and one had granulosa-cell tumor. The mean age was 30.8 (20–43) years and mean diameter was 10.1cm (6–22 cm). Two cases had multi-cystic tumor, and all tumors showed no enhancement by contrast magnetic resonance imaging. Laparoscopic ovarian cystectomy was performed in all cases. All cases underwent a secondary laparoscopic surgery as a fertility-sparing surgery and surgical staging including salpingo-oophorectomy of the affected side, partial omentectomy, and peritoneal observation. Appendectomy was performed for one case. The incidence of perioperative morbidities included one case of suspected ureter stenosis. After surgical staging, no case was up-staged, but a residual tumor was found in the affected ovary of one case. After a mean follow-up of 10.3 months (3–19), none had a recurrence or died of the disease. One case had delivered after the two-stage surgery.Conclusions: Laparoscopic surgery might be feasible and an acceptable intervention for reproductive-age women with BOTs.