Introduction/Background Borderline ovarian tumours represent a rather challenging entity requiring a balance between oncological outcomes and the preservation of fertility in younger patients desiring pregnancy. Numerous retrospective studies have explored the outcomes of fertility-sparing surgery (FSS), emphasising its potential advantages in preserving reproductive capacity. However, concerns persist regarding the risk of recurrence and the long-term impact on overall survival. This systematic review aims to provide a comprehensive synthesis of the existing evidence, comparing FSS to radical surgery (RS) with regard to recurrence rates, overall survival and disease-free survival in women diagnosed with borderline ovarian tumours.

Methodology We searched the literature for prospective and retrospective studies comparing FSS to RS in patients with BOT. Primary outcomes were recurrence and disease-free survival. Secondary outcome was overall survival. The ROBINS-I tool was utilised for assessing the risk of bias of included studies. We performed time-to-event and standard pairwise meta-analyses, as appropriate.

Results 26 studies with a total of 5,221 patients were included in our review. No randomised trials were identified. Meta-analysis demonstrated increased risk for recurrence in patients treated with FSS (RR = 3.40, 95% CI [2.22 - 5.20], I² = 45%). Time-to-event analyses showed inferior disease-free survival for FSS (HR = 2.50, 95% CI [1.36 - 4.61], I² = 78%) albeit with similar overall survival compared to radical surgery (HR = 1.07, 95% CI [0.55 - 2.07], I² = 17%).

Conclusion Fertility-sparing surgery is likely associated with increased recurrence rates and inferior disease-free survival compared to radical surgery.

Neither therapeutic approach seems to be superior in terms of overall survival.

Disclosures The authors declare no conflicts of interest.