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2022-RA-1533-ESGO Role of fertility sparing surgery in patients with borderline ovarian tumors
  1. Timo Westermann1,
  2. Florian Heitz1,2,
  3. Beyhan Ataseven1,3,
  4. Nina Pauly1,
  5. Malak Moubarak1,
  6. Aleksandra Strojna1,
  7. Sabrina Kaiser1,
  8. Concin Nicole1,
  9. Julia Welz1,
  10. Vasileios Vrentas1,
  11. Timoleon Dagres1,
  12. Majdi Imterat1,
  13. Helmut Plett4,
  14. Alexander Traut1,
  15. Andreas du Bois1 and
  16. Philipp Harter1
  1. 1Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
  2. 2Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Berlin, Germany
  3. 3Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
  4. 4Department of Gynaecology, Universitätsklinikum Leipzig, Leipzig, Germany


Introduction/Background Borderline ovarian tumors (BOT) are considered rare tumors of the ovary and often occur in young patients, which is why fertility-sparing surgery (FSS) is of great importance.

Methodology Patients treated with a BOT between 1999 and 2022 in our gynecologic oncology center were included in this analysis. In all cases, an external pathological review was performed.

Results Among 469 patients, 365 (77.8%) were identified with FIGO stage I and 104 (22.2%) with FIGO stage ≥II. 138 patients (29.4%) received FSS. Among those patients treated with complete surgical staging, 5/331 (1.5%) relapses and 4/331 (1.2%) malignant transformations were observed, with a recurrence rate of 0/258 (0%) in FIGO I and 5/73 (6.8%) in FIGO II-IV. FSS showed 17/138 (12.3%) recurrences and 1/138 (0.7%) malignant transformation, with a recurrence rate in FIGO I of 6/107 (5.6%) and in FIGO II-IV of 11/31 (35.5%). In the multivariate analysis, FIGO stages III-IV (HR = 22.7; 95% CI: 7.4–69; p <0.001) and FSS (HR = 18.2; 95% CI: 4.8–69; p <0.001) were identified as significant risk factors for recurrence. 35 patients were treated with a recurrence of a BOT. FSS was repeated in 11 (36.7%) patients. After FSS, the recurrence rate was 1/11 (9%). After complete surgical staging, 3/24 (12.5%) patients experienced a recurrence.

Conclusion Patients with BOT who receive a quality assured treatment have a very low risk of a malignant transformation. After individual consideration, FSS is safe in BOT in early FIGO stages. Patients should be counseled about a higher risk of recurrence in cases of FSS, especially in higher FIGO stages. In selected cases, FSS can also be reconsidered in the recurrence situation.

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