Objectives Borderline ovarian tumors (BOT) are an intermediate form of neoplasia, between benign and malignant. The aim of this systematic review is to evaluate clinico-pathological characteristics profile of borderline ovarian tumors , results of conservative management ,determine the predictors of recurrence estimate the proportion of malignant transformation inrecurrent borderline ovarian tumours (BOTs).

Methods Retrospective review of all patients diagnosed, treated and followed up for BOTs between 2010 and 2017 were identified through the Gynaecology Oncology database. Details of management, outcome and survival were retrieved and data were analyzed descriptively and for survival.

Results A total of 103 patients were identified. During the median follow-up of 46.0 months (IQR:23.0 - 74.0), 15 patients (14.56%) developed recurrent disease,6 (40%) had recurrent disease with progression to invasive carcinoma, and 9 (60%) had recurrent disease with borderline or benign histology. Disease-related deaths (4/103; 3.88%) were observed only in patients with progression to invasive carcinoma.Univariate analysis, indicated that type of surgery and the fertility sparing surgery were statistically significant in affecting survival.

Conclusions Borderline ovarian tumors have excellent prognosis and a very low over all risk of recurrence, however the risk of progression to invasive carcinoma and death remains thereby. Fertility sparing surgeries and incomplete staging were associated with higher risk of recurrence. Conservative surgery is a safe option for preserving fertility when appropriate information is given about increased risk of recurrence and necessary longer follow up. Clinicians should pay closer attention to BOT patients with these predictors of recurrence and there is a need for more careful surveillance.