Surgery For Borderline Ovarian Tumors Research Articles

Outcomes of Fertility Sparing Surgery for Borderline Ovarian Tumors

Outcomes of Fertility Sparing Surgery for Borderline Ovarian Tumors

Reproductive outcomes in women opting for fertility preservation after fertility-sparing surgery for borderline ovarian tumors.

What are the reproductive outcomes of women who had fertility preservation (FP) using either oocyte or embryo vitrification after fertility-sparing surgery (FSS) for a borderline ovarian tumor (BOT)? A retrospective, single-center cohort study was conducted between January 2013 and December 2021. Patients with BOT who resorted to FP by vitrifying oocytes or embryos were included. Both clinical and reproductive parameters were reviewed. The primary outcome was live birth. In total, thirteen patients who performed 31 FP cycles were included. Of those, six patients achieved eight live births after a mean follow-up period of 79 months. Three further pregnancies are still ongoing. All pregnancies/live births were obtained without using their cryopreserved oocytes or embryos. Women who had FSS for BOT have favorable prospects of live offspring, even without the need to use their cryopreserved material. Fertility preservation in patients with BOT has to be considered as a tool to mitigate the risk of infertility that may arise in case of BOT recurrence requiring castrating surgery.

Oncologic and reproductive outcomes of fertility-sparing surgery for borderline ovarian tumors: First presentation of 10-year experience from a Serbian referral center

The study aimed to assess the oncologic and reproductive outcome of fertility-sparing treatment of stage I borderline ovarian tumors (BOTs). A retrospective study of patients aged 18-40 years with stage I BOTs surgically treated during a 10-year period was conducted. In total, 52 patients (average age 32.7+/-5.9) were followed for 16 to 137 months after BOT diagnosis (mean 73.4 months). The overall survival rate was 100%. Recurrence was registered in 4 patients (7.7%). All patients underwent a unilateral salpingo-oophorectomy and all histologic findings corresponded with primary BOTs (3 serous; 1 endometrioid). Higher parity increased while the histological type and stage did not impact recurrence. Average recurrence-free survival was 36.2+/-23.6 months regardless of histological type and stage. Recurrence occurred during the first 3 postoperative years in 75% of cases. Out of 45 women treated with fertility-sparing surgery, 64.4% attempted pregnancy and the pregnancy success rate was 44.8%. Only one pregnancy was conceived by assisted reproduction, while all others were spontaneous. The fertility-sparing treatment in stage I borderline ovarian tumors can be a safe and successful option both in terms of oncologic and reproductive outcomes, regardless of patient and treatment characteristics. Pregnancies after BOT surgery can be achieved with satisfactory rates and adequate outcomes.

Prescription of hormone replacement therapy in women with surgically induced menopause and borderline ovarian tumors: Should we be doing more?

Borderline Ovarian Tumors (BOT) are often diagnosed in premenopausal women and the likely precursors to ovarian low-grade serous carcinoma (LGSC), a hormonally sensitive malignancy. The safety of hormone replacement therapy (HRT) after surgical treatment of BOT is unknown. We aimed to describe the HRT prescribing and preventive services practice patterns in women with surgically induced menopause (SIM) after surgery for BOT. (See Table 1.)

Can we safely forgo hysterectomy in non-fertility-sparing surgery for borderline ovarian tumors?

Forgoing hysterectomy as part of borderline ovarian tumor (BOT) staging is considered appropriate for fertility preservation. We evaluated whether forgoing hysterectomy may also be acceptable in non-fertility-sparing surgery by evaluating the frequency of uterine involvement and the rate of recurrence involving the uterus. A review of all BOTs at one institution over ten years (2009–2019) was performed. Patients with hysterectomy prior to BOT diagnosis were excluded. Data were abstracted from electronic medical records. Bivariate statistics were used to compare groups.129 patients with BOT on final pathology were identified. 67 cases included hysterectomy. Reasons for no hysterectomy (n = 62) included fertility preservation (40), benign intraoperative frozen pathology (4), patient preference (3), comorbidities (7), and unknown (8). Four of 67 (6.0%) uterine specimens had non-invasive serosal implants, of which two had grossly visible uterine involvement and all four had grossly visible extrauterine peritoneal disease. 12 of 129 (9.3%) patients had documented recurrence, of which all had uterine preservation at the time of initial surgery. Of the 12 recurrences with uterus in situ, none were documented to involve the uterus, and all were composed of non-invasive implants. In patients with BOT grossly confined to ovaries at the time of surgery, we found no cases of uterine involvement. We found no cases in which microscopic uterine serosal involvement changed stage and no cases of recurrence involving the uterus. Hysterectomy may be able to be safely excluded from non-fertility-sparing surgery for BOTs, particularly when disease is grossly confined to the ovaries.

Can we safely forgo hysterectomy in non-fertility sparing surgery for borderline ovarian tumors?

There is contradictory evidence on the role of comprehensive staging for borderline ovarian tumors (BOTs). Microscopic non-invasive implants generally do not change adjuvant therapy or prognosis. Forgoing hysterectomy as part of BOT staging is appropriate in the setting of fertility preservation. We aimed to evaluate whether forgoing hysterectomy may also be acceptable in non-fertility sparing surgery by evaluating the frequency of finding microscopic uterine involvement and the rate of uterine involvement at time of recurrence.

Reproductive and obstetrical outcomes with the overall survival of fertile-age women treated with fertility-sparing surgery for borderline ovarian tumors in Sweden: a prospective nationwide population-based study

To assess the efficacy of fertility-sparing surgery (FSS) in terms of reproductive outcomes by following FSS for borderline ovarian tumors (BOTs) and comparing the safety of FSS versus radical surgery (RS). Nationwide cohort study based on prospectively recorded data. Sweden. All women of reproductive age (18-40 years) treated in Sweden for stage I BOT with the use of FSS or RS from 2008 to 2015, identified in the Swedish Quality Registry for Gynecologic Cancer (SQRGC). FSS or RS. Reproductive outcomes: natural conception, use of assisted reproductive technology (ART), live birth and obstetrical outcomes. Safety outcome: overall survival (OS) rates, comparing women undergoing FSS versus RS. The FSS cohort was linked to the Swedish Medical Birth Register to identify all women who had given birth after FSS and to obtain detailed obstetrical data. For information on ART treatment, the National Quality Registry for Assisted Reproduction was consulted. OS rate comparisons were conducted by means of Kaplan-Meier estimates. Of the 277 women with BOTs, 213 (77%) underwent FSS, 183 (86%) unilateral salpingo-oophorectomy, and 30 (14%) cystectomy. Following FSS, 50 women gave birth to 62 healthy children, 8% of which were preterm. Only 20 (9%) of the women underwent ART treatment. OS was similar in women treated with FSS and RS. Natural fertility was maintained after FSS; only 9% required ART treatment. FSS was also deemed to be equivalent to RS regarding survival outcome.

Live Births after in vitro Fertilization with Fertility-Sparing Surgery for Borderline Ovarian Tumors: A Case Series and Literature Review

This is a case series reporting live births following in vitro fertilization (IVF) after fertility-sparing surgery in patients with borderline ovarian tumors (BOTs). Seventeen patients, in whom fertility-sparing surgery for BOTs followed by IVF was performed from July 1, 2011 to September 30, 2017, in our IVF center, were included. Here we retrospectively present their BOT characteristics and clinical outcomes of assisted reproduction technology (ART) and then discuss the literature on management of patients with BOTs after fertility-sparing surgery. The study sample of 17 patients started IVF-assisted reproduction within a median of 24 months after fertility-sparing surgery. Eight patients achieved live births after IVF followed by fresh or frozen-thawed embryo transfer, and one is currently pregnant after the second IVF treatment. Four of these 17 women experienced 6 recurrences of BOTs after IVF and delivery in a median of 29 months of follow-up. The literature reports a pooled estimate of 63.5% for pregnancy and 21.7% for recurrence of BOTs in patients with the same condition. Pregnancy outcomes of IVF in these women are usually better than those of generally infertile women. Moreover, our review of the literature suggests that ART has no negative impact on the prognosis of BOTs.

Short-term Outcomes and Pregnancy Rate After Laparoscopic Fertility-Sparing Surgery for Borderline Ovarian Tumors

ObjectiveWe investigated the short-term outcomes and pregnancy rate after a laparoscopic approach to fertility preservation in patients with borderline ovarian tumors (BOTs).MethodsClinic-pathologic variants of patients with BOTs who underwent conservative surgery at the Tianjin Central Hospital of Obstetrics and Gynecology between January 2009 and July 2015 were retrospectively analyzed.ResultsAmong 211 patients with BOTs, 74 (35.1%) received conservative surgery (44 cases using a laparoscopic approach and 30 cases using a laparotomy approach). The mean age of the laparotomy group was significantly younger than that of the laparoscopic group (P = 0.024). The maximal longitude of the tumor in the laparotomy group was significantly longer than that in the laparoscopic group (P < 0.001). The number of incomplete surgery cases in the laparoscopic group was significantly greater than that in the laparotomy group (P < 0.001). The 2 groups showed no significant differences in gravidity and parity before surgery, abnormality of serum tumor makers, tumor lateralities, ascites, histology, duration of follow-up, pregnancy rate after surgery, or postoperative recurrence. Total recurrent rate was 6.7% (5/74). Two cases in laparotomy group and 3 cases in laparoscopic group relapsed respectively. There was no significant difference of recurrent rate between the 2 groups. The total pregnant rate was 33.8% (25/74). Nine patients (30%) in the laparotomy group and 16 patients (36.4%) in the laparoscopic group became pregnant during follow-up respectively. There were no significant differences in the postoperative durations of pregnancy, pregnancy type, age at pregnancy, tumor lateralities, ascites, or type of pathology between 2 groups. The pregnancy rate of incomplete surgery cases in laparoscopic group was significantly higher than that of laparotomy group (P = 0.011). No recurrence occurred among the pregnant cases.ConclusionsA comprehensive laparoscopic surgery was not performed in incomplete surgery patients undergoing complete exploration. Good short-term outcomes and pregnancy were observed in patients receiving conservative laparoscopic surgery for BOTs, especially in patients receiving incomplete conservative laparoscopic surgery.

Oncologic and obstetric outcomes of conservative surgery for borderline ovarian tumors in women of reproductive age.

ObjectiveTo compare the oncologic and obstetric outcomes in reproductive-age females with borderline ovarian tumors (BOTs) treated with cyst enucleation (CE) or unilateral salpingo-oophorectomy (USO).MethodsThe medical records of patients with BOTs treated between 1998 and 2014 were retrospectively reviewed. The recurrence rates in the USO and CE groups were compared, and the postoperative obstetric outcomes were assessed via telephone survey.ResultsEighty-nine patients with BOTs underwent USO, and 19 underwent CE. Of these, six patients had recurrent BOTs. The recurrence rate was significantly lower in the USO group (3/89, 3.4%) than in the CE group (3/19, 15.8%) (P=0.032). All patients with recurrent disease were successfully treated with further surgery. Of the 76 patients interviewed by telephone, 71 (93.4%) resumed regular menstruation after surgery. Twenty-six of the 32 patients (81.3%) who attempted to conceive had successful pregnancies. USO (19/24, 79.2%), like CE (7/8, 87.5%), resulted in favorable pregnancy rates for patients with BOTs.ConclusionUSO is a suitable fertility-preserving surgery for women with BOTs. CE is also an acceptable option for select patients.

Nomogram to predict live birth rate after fertility-sparing surgery for borderline ovarian tumours

Can a nomogram be used to predict the individual probability of live birth (LB) in women with borderline ovarian tumours (BOTs) receiving primary fertility-sparing surgery? A nomogram built according to the woman's age, histological subtype (serous versus mucinous), type of ovarian surgical treatment and FIGO stage can accurately predict the probability of LB in women with BOT. Current prediction models determine the probability of pregnancy after medically assisted reproduction (MAR) and form the basis of patient counselling to guide the decision as to whether to consider in vitro fertilization but do not take into account prediction of the LB rate. This was a retrospective multi-centre study including 187 women with fertility-sparing surgery for BOT diagnosed between January 1980 and December 2013. A multivariate logistic regression analysis of selected factors and a nomogram to predict the subsequent LB rate was constructed. A bootstrapping technique was used for internal validation. Fifty-one women had LB (27.3%). Taking into account multiple pregnancies, the overall LB rate was 40.1% (75/187). Federation International of Gynaecology and Obstetric (FIGO) stage, age at diagnosis, histological subtype and surgery type were included in the nomogram. The predictive model had an AUC of 0.742 (95% CI, 0.644-0.825) and 0.72 (95% CI, 0.621-0.805) before and after the 200 repetitions of bootstrap sample corrections, respectively, and showed a good calibration. The retrospective nature of the study cannot exclude all biases. Our nomogram is based on simple criteria, but did not take into account the evaluation of ovarian reserve. It demonstrates a fair relevance, but requires external validation before routine use. Clinicians are increasingly interested in such tools to support the patient in making an informed decision about treatment options. This nomogram contributes to the decision-making by defining simple risk factors of poor LB probability that can help identify good candidates for MAR. No external funding was used for this study. There are no conflicts of interest to declare. N/A.

Pregnancy after fertility-sparing surgery for borderline ovarian tumors

ObjectiveTo investigate the ability to conceive and the factors affecting chances of pregnancy among patients with borderline ovarian tumors (BOTs) treated with fertility-sparing surgery. MethodsA retrospective study included nulliparous patients aged 40years or younger who had undergone fertility-sparing surgery for BOTs between January 2005 and June 2012 at a center in Fuzhou, China. Identified patients were followed up by telephone or mail between March 15 and June 30, 2013. Patients who had already been pregnant and those who had not but had discontinued contraception for more than 1year were included in final analyses. ResultsAmong 23 included patients, 17 (74%) had become pregnant within the mean follow-up period of 48.2months. The frequencies of previous infertility, sequelae of pelvic inflammatory disease, and endometriosis were all higher in the nonpregnant group than in the pregnant group (P≤0.021 for all). More women in the nonpregnant group that in the pregnant group had BOTs of stage II or worse, but the difference was nonsignificant (P=0.059). ConclusionFertility-sparing surgery in young patients with BOTs is associated with a good pregnancy rate. However, the tumor stage and coexisting infertility factors are important considerations in selecting the optimal surgical approach.

Recurrence of borderline ovarian tumour after fertility treatment

Background Borderline ovarian tumours account for 10–20% of all epithelial ovarian tumours. As one-third of these tumours are seen in women less than 40 years of age, fertility remains a major concern in their management. Conservative surgery has been advocated in these cases. Fertility treatment has been successfully used in some of these cases with good results. However, the risk of tumour recurrence cannot be ignored. Case report A young nulliparous woman had fertility sparing surgery (bilateral salpingo-oophorectomy and omentectomy) for serous borderline ovarian tumours with noninvasive implants (stage IIIc). After 10 years of uneventful follow-up, she decided to undergo an in-vitro fertilization with donor oocytes. She received unopposed oestrogen stimulation for 12 days to prime the endometrium and developed ascites. Subsequent investigations revealed tumour recurrence in the form of low-grade serous adenocarcinoma. The carcinoma proved resistant to chemotherapy and pursued an aggressive course culminating in death within 6 months of diagnosis. Conclusion Borderline ovarian tumours can recur in an aggressive manner even after a prolonged follow-up. Large clinical trials with longer follow-up are needed to evaluate the safety of controlled ovarian hyperstimulation after conservative surgery for borderline ovarian tumours.

Gonadotropin-releasing hormone agonists cotreatment during chemotherapy in borderline ovarian tumor and ovarian cancer patients

Background Recently, conservative surgery is acceptable in young patients with borderline ovarian tumor and ovarian cancer. The preservation of these patients' future fertility has been the focus of recent interest. This study aimed to observe the effect of gonadotropin-releasing hormone agonists (GnRHa) cotreatment during chemotherapy in borderline ovarian tumor and ovarian cancer patients. Methods Sixteen patients who were treated with fertility preservation surgery for borderline ovarian tumor and ovarian cancer and then administered GnRHa during chemotherapy in Peking University People's Hospital from January 2006 to July 2010 were retrospectively analyzed. This group was compared with a control group of 16 women who were treated concurrently with similar chemotherapy (n=5) without GnRHa or were historical controls (n=11). The disease recurrence, the menstruation status and reproductive outcome were followed up and compared between the two groups. Results There were no significant differences between both groups regarding age, body weight, height, marriage status, classification of the tumors, stage of the disease, as were the cumulative doses of each chemotherapeutic agent. One (1/16) patient in the study group while 2 (2/16) patients in the control group relapsed 2 years after conclusion of the primary treatment (P &gt;0.05). All of the 16 women in the study group compared with 11 of the 16 patients in the control group resumed normal menses 6 months after the termination of the treatment (P &lt;0.05). There were 4 spontaneous pregnancies in the study group while 2 in the control group, all of the neonates were healthy. Conclusions GnRHa administration before and during chemotherapy in borderline ovarian tumor and ovarian cancer patients who had undergone fertility preservation operation may bring up higher rates of spontaneous resumption of menses and a better pregnancy rate. Long-term follow up and large scale clinical studies are required.

Nomogram to Predict the Probability of Relapse in Patients Diagnosed With Borderline Ovarian Tumors

This study aimed to develop a nomogram predicting the probability of relapse in individual patients who have surgery for borderline ovarian tumors (BOTs). This retrospective study included 801 patients with BOT diagnosed between 1985 and 2008 at 6 gynecologic cancer centers. We analyzed covariates that were associated with the risk of developing a recurrence by multivariate logistic regression. We identified a parsimonious model by backward stepwise logistic regression. The 5 most significant or clinically important variables associated with an increased risk of recurrence were included in the nomogram. The nomogram was internally validated. Fifty-one patients developed a recurrence after a median observation period of 57 months. Age at diagnosis, the International Federation of Gynecology and Obstetrics stage, cell type, preoperative serum CA125, and type of surgery (radical vs fertility-sparing) were associated with an increased risk of recurrence and were used in the nomogram. Bootstrap-corrected concordance index was 0.67 and showed good calibration. Five factors that are commonly available to clinicians treating patients with BOT were used in the development of a nomogram to predict the risk of recurrence. The nomogram will be useful to counsel patients about risk-reduction strategies to minimize the risk of recurrence or to inform patients about a very low risk of recurrence making intensive follow-up unwarranted.

Unilateral salpingo-oophorectomy as fertility-sparing surgery for borderline ovarian tumors

Background To investigate recurrence rates and fertility outcomes of patients with borderline ovarian tumors (BOTs) treated with fertility-sparing surgery. Methods This was a retrospective study. All women with BOTs from 2000 to 2006 were evaluated. Clinical outcomes were compared among groups that underwent radical, unilateral salpingo-oophorectomy, or ovarian cystectomy. The effects of clinical characteristics on recurrence were analyzed by independent t test, chi-square test, and Cox proportional hazard model. Results After a mean follow-up period of 56.5 months, all 61 patients were alive. Seven (11.5%) had developed disease recurrence, and all were in the fertility-sparing group. Of these, five were in the cystectomy-only group and two in the unilateral salpingo-oophorectomy group. There was significant difference in tumor recurrence rates between the two groups (hazard ratio: 0.26, 95% confidence interval: 0.11–0.61). Nine pregnancies were achieved in six women, resulting in five deliveries Conclusion Fertility-sparing surgery is an acceptable and safe option for women with BOTs who wish to preserve fertility. Unilateral salpingo-oophorectomy must be considered as the first choice.

Fertility-Sparing Surgery for Borderline Ovarian Tumors: Oncologic Safety and Reproductive Outcomes

To evaluate the oncological safety and reproductive outcomes of patients with borderline ovarian tumors (BOTs) treated with fertility-sparing surgery. Patients with BOTs who underwent radical or fertility-sparing surgery between 1997 and 2009 were identified from an institutional database. The recurrence rates were compared between the 2 surgery groups. To compare the reproductive outcomes, all patients who underwent fertility-sparing surgery were interviewed by telephone. One hundred forty-three patients underwent radical surgery, and 155 patients underwent fertility-sparing surgery. After a median interval of 38 months from the initial surgery (range, 10-77 months), 19 patients had a recurrence. The recurrence rate was similar in the radical and fertility-sparing surgery groups (4.9% and 7.7%, respectively; P = 0.280). In the fertility-sparing surgery group, however, the main site of recurrence was the remaining ovary that was successfully salvaged with a second round of fertility-sparing surgery. Of 51 patients who attempted to conceive, 45 patients (88.2%) were successful and resulted in 54 term deliveries. Fertility-sparing surgery for BOTs is safe and can result in future pregnancies, suggesting that such surgery should be considered for young patients who desire preservation of fertility.

Fertility outcome after conservative surgery for borderline ovarian tumors: a single center experience

The present study aims to document the experience of a single center on the reproductive outcome of a cohort of women who were treated with conservative surgery for borderline ovarian tumors and to specify whether their fertility potential is associated with age, tumor histology and surgery type. A total of 55 women who had undergone conservative surgery for borderline ovarian tumors between January 1999 and January 2009 were eligible. Recurrence rate, fertility outcome and the number of pregnancies were analyzed retrospectively. Among the study group, 11 women were not sexually active both at the time of surgery and during the follow-up period. Thus, a total of 44 patients attempted pregnancy after conservative surgery and 52.3% of them (23 out of 44) were able to conceive either spontaneously or by in vitro fertilization. The ability to conceive was shown to be associated with age, tumor histology and type of conservative surgery. As expected, the fertility potential correlated positively with decreasing age (correlation coefficient = 0.705, p = 0.001). Moreover, the existence of non-serous histology and the implementation of unilateral cystectomy were found to be associated with the ability to reach a clinical pregnancy (correlation coefficient = 0.585, p = 0.001 and correlation coefficient = 0.587, p = 0.001, respectively). The primary treatment of borderline ovarian tumors refers to conservative surgery. Younger age, non-serous histology and unilateral cystectomy appear to be associated with favorable reproductive outcome in women who undergo conservative surgery for borderline malignancy of ovary.

Interventions for the treatment of borderline ovarian tumours

The safety of conservative surgery and the benefit of additional interventions after surgery for borderline ovarian tumours are unknown. To evaluate the benefits and harm of different treatment modalities offered for borderline ovarian tumours. We searched the Cochrane Gynaecological Cancer Group Trials Register to 2009, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 4), MEDLINE and EMBASE to 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies. Randomised controlled trials (RCTs) that compared different interventions in adult women diagnosed with borderline ovarian tumours of any histological variant. Two review authors independently abstracted data and assessed risk of bias. We identified seven RCTs that enrolled 372 women. We could not pool results of trials as the treatment comparisons differed.Six RCTs (n = 340) conducted over 15 years ago, evaluated adjuvant therapy (chemotherapy, pelvic external irradiation or intra-peritoneal radioactive isotope therapy) after radical surgery; over 87% of participants had Stage I tumours. Most participants were followed up for over 10 years. Overall and recurrence-free survival were similar between both arms of these trials, except that one trial (n = 66) showed a significantly lower survival (P = 0.03) in women who received chemotherapy (thio-TEPA). Adverse effects of treatment were incompletely reported and all six trials were at high risk of bias.One further trial (n = 32) that recruited participants with bilateral serous tumours who were wishing fertility preservation, revealed a significantly increased chance of pregnancy (hazard ratio (HR) = 3.3, 95% CI 1.4 to 8.0) but non-significantly earlier disease recurrence (HR = 1.5, 95% CI 0.6 to 3.8) in the women who had ultra-conservative surgery (bilateral cystectomy) than in those who had conservative surgery (cystectomy and contralateral oophorectomy). This trial was at low risk of bias.Quality of life (QoL) was not documented in any included trial. We did not find any trials that compared radical with conservative surgery or laparoscopy with laparotomy. We did not find evidence to support the use of any specific type of adjuvant therapy for borderline ovarian tumours. RCTs evaluating the benefit of adjuvant therapy with optimally dosed chemotherapy and newer targeted drugs are necessary, particularly for advanced borderline ovarian tumours. The low mortality from borderline ovarian tumours should make recurrence-free survival, time to recurrence and morbidity important end points in such trials.Bilateral cystectomy may be offered to women with bilateral borderline ovarian tumours diagnosed intra-operatively who are wishing to preserve their fertility. Similarly, women who had RCTs comparing radical with conservative surgery and comparing laparoscopy with laparotomy are needed.

Comparison of Laparoscopic and Laparotomic Surgery for Borderline Ovarian Tumor

Study Objective: To compare the surgical and survival outcomes after surgery by laparoscopy or laparotomy for borderline ovarian tumors. Design: Retrospective analysis. Setting: Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea. Patients: Three hundred thirty six patients with borderline ovarian tumor. Intervention: Laparoscopic or laparotomic surgical management for borderline ovarian tumor. Measurements and Main Results: Of 336 patients with borderline ovarian tumor, 245 patients underwent laparoscopic surgery and 91 patients underwent laparoscopic surgery from 1997 to 2009. Age, parity, and body mass index was similar between the two surgery groups. Menopausal women was more in laparoscopy group. Mean tumor size was higher in laparotomy group. FIGO stage, histologic type, bilaterality of tumor, microinvasion, micropapillary pattern, invasive implant, intraoperative tumor rupture, malignant ascites or cytology, and preoperative CA 125 level were not different between the two surgery groups. However, conservative management, use of ovarian cystectomy were more common in laparoscopy group, and comprehensive surgical staging including lymph node dissection and omentectomy were more common in laparotomy group. After mean follow-up time of 56 months (range, 3–132 months), recurrence rate (5.1% vs 4.2%, p = 0.763) and death rate (1.7% vs 1.4%, p = 0.864) were not different between the two surgery groups. Five year disease-free survival was 94% and 98%, respectively (p = 0.8827), and 5-year overall survival rate was 98% in both groups (p = 0.9643). Conclusion: Laparoscopic surgery for borderline ovarian tumor was feasible in most cases. Although comprehensive staging procedure was less frequently used and comservative management was adopted more frequently, the survival was not compromised. Laparoscopic surgery may be a safe and reasonable alternative to laparotomic surgery in the management of borderline ovarian tumor.