The role of restaging borderline ovarian tumors: Single institution experience and review of the literature

doi:10.1016/j.ygyno.2010.07.034

Gynecologic Oncology

Volume 119, Issue 2, November 2010, Pages 274-277

https://doi.org/10.1016/j.ygyno.2010.07.034 Get rights and content

Abstract

Background

Borderline ovarian tumors (BOTs) are a histological category of epithelial ovarian tumors and 70% of them are early diagnosed (stage I). Since early stage is the most important prognostic factor, restaging procedure could be justified. This study aims to evaluate the role of restaging surgery in the management of patients with borderline ovarian tumors referred to our Institution after being incompletely surgically staged in other hospitals.

Materials and methods

We retrospectively reviewed the charts of patients with BOT who were referred to our centre to undergo restaging procedure. From December 1995 to May 2008, 186 patients were treated for BOT and 70 patients met the inclusion criteria. Data collected included patients' age, primary and re-staging surgery details, FIGO stage after first and second procedure, pathological findings, and follow-up data.

Results

FIGO stage after primary surgery was IA in 46 patients (68.6%), IB in 7 patients (10.4%), IC in 12 patients (17.9%, 6 due to ruptured cyst), IIA in 1 patient (1.4%), IIB in 1 patient (1.4%), III B in 2 patients (2.8%), and IIIC in 1 patient (1.4%). Among stage I patients (representing 97% of all patients), 12.3% (8 patients) were up-staged. The upstaging rate among serous tumors was 16.2%, and 4% among mucinous tumors. The mean follow-up time was 60.4 months from restaging surgery (SD 30.6 months). We observed 8 primary recurrences of the disease and 3 second recurrences.

Conclusions

There were no differences in terms of overall survival between patients who were upstaged and those who were not. Restaging procedure does not seem to have a significant impact on the management of patients diagnosed with borderline ovarian tumors, especially in mucinous subtype and apparent FIGO stage higher than I.

Introduction

Borderline ovarian tumors (BOTs) were first described by Taylor in 1929 [1] and were introduced in 1971 by FIGO [2] as a category of epithelial ovarian tumors. They account for 10–15% of all ovarian epithelial tumors, primarily diagnosed in young women [3], [4], [5]. Approximately 70% of these tumors are stage I at the time of diagnosis with a 5-year survival rate of 95–97% [6]. Malignant transformation occurs in less than 0.5%, although extra-ovarian lesions, such as invasive implants, are more frequent (up to 35% in some series [7]). Therefore, both prognosis and adjuvant treatment of these tumors depend on the presence of the implants. Since early stage is the most important prognostic factor, restaging procedure could be justified. However, according to the data from the literature the issue is still controversial [8].

The aim of this study is to evaluate the role of restaging in the management of borderline ovarian tumors by analysing data on patients referred to our center after being diagnosed in other institutions, and by reviewing the available literature.

Section snippets

Materials and methods

Further to the approval of the Institutional Review Board, we retrospectively reviewed the clinical records of patients with borderline ovarian tumors referred to our centre further to diagnostic surgery in other hospitals to be submitted to restaging. From December 1995 to May 2008, 186 patients were treated at our institution for BOT.

The data collected included patients' age, primary surgery, restaging surgery, FIGO stage at first and second procedure, pathological findings, and follow-up

Results

Among the 186 records reviewed, 70 met the inclusion criteria described above. The median age was 43 years (range 14 to 71 years). The different procedures carried out as primary surgery and restaging surgery are listed in Table 1. After primary surgery, only 5 patients (7%) had abnormal CA125 values and three (43%) of them were eventually upstaged.

The median time from the first surgery to the restaging procedure was 132 days (range 15 to 330 days). The median length of stay was 2.7 days (range 1 to

Discussion

The role of surgical restaging for borderline ovarian tumors is still controversial. Guidelines on BOTs surgical staging are the same as those of invasive ovarian tumors [11]. The role of retroperitoneal restaging remains unclear for borderline ovarian tumors and it does not seem to be as crucial as for the malignant counterparts [12], since in the latter it may have both prognostic and therapeutic implications. The results of a study conducted by Seidman and Kurman [13] suggested that

Conflict of interest statement

The authors declare that they have no conflict of interest.

Acknowledgment

We would like to thank very much Lucia Zigliani for the editing of the manuscript.

References (25)

R. Tinelli et al.
Feasibility, safety, and efficacy of conservative laparoscopic treatment of borderline ovarian tumors
Fertil Steril
(2009)
R. Tinelli et al.
Conservative surgery for borderline ovarian tumors: a review
Gynecol Oncol
(2006)
D.M. Gershenson
Clinical management potential tumours of low malignancy
Best Pract Res Clin Obstet Gynaecol
(2002)
J.D. Seidman et al.
Ovarian serous borderline tumors: a critical review of the literature with emphasis on prognostic indicators
Hum Pathol
(2000)
R. Yazigi et al.
Primary staging in ovarian tumors of low malignant potential
Gynecol Oncol
(1988)
D.D. Snider et al.
Evalutation of surgical staging in stage I low malignant potential ovarian tumors
Gynecol Oncol
(1991)
L.W. Rice et al.
Epithelial ovarian tumors of borderline malignancy
Gynecol Oncol
(1990)
A.C. Casey et al.
Epithelial ovarian tumors of borderline malignancy: long-term follow up
Gynecol Oncol
(1993)
D. Querleu et al.
Laparoscopic restaging of borderline ovarian tumors: results of 30 cases initially presumed as stage Ia borderline ovarian tumors
BJOG
(2003)
W.E. Winter et al.
Surgical staging in patients with ovarian tumors of low malignant potential
Obstet Gynecol
(Oct 2002)

H.C. Taylor

Malignant and semimalignant tumors of the ovary

Surg Gynecol Obstet

(1929)

International Federation of Gynecology and Obstetrics Classification and staging of malignant tumors in the female pelvis

Acta Obstet Gynecol Scand

(1971)

Cited by (35)

Risk factors for recurrence of borderline ovarian tumors in France: A multicenter retrospective study by the FRANCOGYN group
2021, Journal of Gynecology Obstetrics and Human Reproduction
Borderline ovarian tumors (BOTs) although rare, have shown an increase in the incidence worldwide. Although the survival rate is high, the recurrence rate is estimated to be between 5% and 34%. The objective of this study was to identify risk factors for recurrence of BOTs.
This retrospective multicenter study included 493 patients treated surgically for BOT between January 2001 and December 2018.
Thirty-seven patients showed recurrence (group R, 7.5%), while 456 did not (group NR, 92.5%). With an average follow-up of 30.5 months (1-276), the overall recurrence rate was 7.5%. Recurrence rates for the BOT and invasive types were 5.7% (n = 28) and 1.4% (n = 7), respectively. The mean time to recurrence was 44.1 (3-251) months. Univariate analysis showed that age at diagnosis, type of surgical procedure, histological type, and FIGO stage were factors influencing recurrence. Multivariate analysis showed that the risk factors for recurrence of BOT were conservative treatment (OR = 7 [95% CI 3.01-16.23]; p < 0.05) and advanced FIGO stage (OR = 5.86 [95% CI 2.21-15.5]; p < 0.05).
To the best of our knowledge, this multicenter study was one of the largest studies on the risk factors for BOT recurrence. Conservative treatment and advanced FIGO stage were identified as risk factors for BOT recurrence. These results reinforce the need for restaging of patients who did not have an optimal initial surgical staging so as not to avoid missing a tumor in the advanced stage. Referral to a surgical oncology center is suggested to optimize overall patient management.
Management of borderline ovarian tumours during pregnancy: Results of a French multi-centre study
2021, European Journal of Obstetrics and Gynecology and Reproductive Biology
Citation Excerpt :
In the present study, BOTs were commonly reclassified due to the frequent occurrence of intra- or pre-operative rupture (n = 7, 50 % of cases), but remained FIGO stage I. Only one case was upstaged to FIGO stage IIB; this was a micropapillary serous BOT with a micro-invasive implant (Case 13). Therefore, few cases in this study required upstaging, which is consistent with the literature [15,30]. In addition to the micropapillary component, other prognostic factors have been identified recently in the risk of recurrence for FIGO stage I serous BOTs (i.e. most BOTs detected during pregnancy), such as young age (<30 years), conservative treatment by cystectomy, and bilateral character [31].
To assess the diagnostic and prognostic characteristics of borderline ovarian tumours (BOTs) detected during pregnancy, and to establish an inventory of French practices.
A retrospective multi-centre case study of 14 patients treated for BOTs, diagnosed during pregnancy between 2005 and 2017, in five French pelvic cancerology expert centres, including data on clinical characteristics, histological tumour characteristics, surgical procedure, adjuvant treatments, follow-up and fertility.
The mean age of patients was 29.3 [standard deviation (SD) 6.2] years. Most BOTs were diagnosed on ultrasonography in the first trimester (85.7 %), and most of these cases (78.5 %) also underwent magnetic resonance imaging to confirm the diagnosis (true positives 54.5 %). Most patients underwent surgery during pregnancy (57 %), with complete staging surgery in two cases (14.3 %). Laparoscopy was performed more frequently than other procedures (50 %), and unilateral adnexectomy was more common than cystectomy (57.5 %). Tumour size influenced the surgical approach significantly (mean size 7.5 cm for laparoscopy, 11.9 cm for laparoconversion, 14 cm for primary laparotomy; P = 0.08), but the type of resection did not. Most patients were initially diagnosed with International Federation of Gynecology and Obstetrics stage IA (92.8 %) tumours, but many were upstaged after complete restaging surgery (57.1 %). Most BOTs were serous (50 %), two cases had a micropapillary component (28.5 %), and one case had a micro-invasive implant. BOTs were bilateral in two cases (14.2 %). Mean follow-up was 31.4 (SD 14.8) months. Recurrent lesions occurred in two patients (14.2 %) and no deaths have been recorded to date among the study population.
BOTs remain rare, but this study – despite its small sample size – supports the hypothesis that BOTs during pregnancy have potentially aggressive characteristics.
Impact of surgical restaging on recurrence in patients with borderline ovarian tumors: A meta-analysis
2020, European Journal of Obstetrics and Gynecology and Reproductive Biology
Citation Excerpt :
A manual search of the references cited in these papers did not yield additional relevant studies. Twenty-one studies were incomplete and provided insufficient data for calculation [7,13–32] and four were non-comparative case series [33–36]. These studies were excluded from further analysis.
The benefits of restaging surgery for patients with a borderline ovarian tumor (BOT) discovered on initial surgery are debatable. We performed a meta-analysis to evaluate the role of restaging surgery on recurrence in patients with BOTs.
We systematically reviewed published studies comparing restaging surgery and incomplete surgery in BOT patients from January 1985 to December 2017. Endpoints were recurrence and mortality rates. Study design features that possibly affected participant selection, reporting of recurrence and death, and manuscript publication were assessed. For pooled estimates of the effect of restaging surgery on recurrence, fixed-effect meta-analytical models were used.
Of the 577 articles initially selected, four retrospective observational studies (Restaging group: 166 patients; Non-Restaging group: 394 patients) met our research criteria. No significant differences in terms of recurrence between the two groups were observed (pooled Peto Odds Ratio [OR] = 0.88; 95 % confidence interval [CI]: 0.41–1.92). The number of deaths was insufficient for statistical analysis.
This meta-analysis based on retrospective studies, suggests that restaging surgery does not significantly reduce recurrence in patients with BOT.
Comparison between laparoscopy and laparotomy in the surgical re-staging of granulosa cell tumors of the ovary
2020, Gynecologic Oncology
To evaluate the role of laparoscopic (LPS) and laparotomic (LPT) re-staging in patients with incompletely surgically staged ovarian granulosa cell tumors (OGCT).
We conducted a medical chart retrospective analysis of all patients with sex cord stromal tumors (SCSTs) who were managed in our division between March 1994 and March 2017. After a complete review of surgical and pathological notes, patients with incomplete staging were restaged according to the FIGO guidelines. Statistical analysis was conducted using Statistical Package version 20.0 for Windows (SPSS, Inc., Chicago, Illinois).
Out of a total of 170 patients SCSTs, 84 patients (49,5%) received primary surgery that included a hysterectomy; 86 patients (50,5%) underwent fertility-sparing surgery. Eighty-one patients (48%) with diagnosis of OGCT were incompletely surgically staged at another institution. We evaluated our results in terms of laparoscopic approach (56 patients) and open treatment (25 patients). Among the IA patient's group, 1 was upstaged to IIB stage and 2 to IIIB; among patients with IC stage, 1 was upstaged to IIA, 2 to IIB and 1 to IIIB stage. Adjuvant chemotherapy was given to the upstaged patients with final stage IIB-IIIC. No statistically significant difference between laparoscopy and open-surgery was detected in terms of upstaged patients after second surgery (p = 0,36).
According to our series, laparoscopic restaging compared to the open approach seems to be a feasible and efficient technique to complete surgical staging in patients with GCTs incorrectly staged. Surgical restaging seems to upstage a considerable number of OGCT, mainly in the initial stage IC group of patients. However, the impact of restaging on final outcome and survival remains to be demonstrated.
Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice – Pregnancy
2020, Gynecologie Obstetrique Fertilite et Senologie
Déterminer la place de l’imagerie, des marqueurs tumoraux, le type de traitement et la voie d’abord chirurgicale, la place de la surveillance, la voie d’accouchement, et la restadification des TFO pendant la grossesse, afin d’émettre des recommandations.
Analyse systématique de la littérature sur les TFO pendant la grossesse, consultée sur PUBMED, des articles publiés entre 1990 et 2019, incluant les mots-clés « borderline ovarian tumor and pregnancy ».
L’échographie pelvienne est l’examen de référence et de première intention pour la détection et la caractérisation des masses annexielles durant la grossesse (grade C). L’IRM pelvienne est recommandée à partir de 12 SA en cas de masse annexielle indéterminée et devra être conclue par un score diagnostique (grade C). L’injection de gadolinium est à limiter au maximum en raison des risques prouvés sur le fœtus et devra être discutée au cas par cas après information de la patiente (grade C). En l’absence de données dans la littérature, il n’est pas possible d’émettre de recommandations quant à l’utilisation de marqueur tumoral pour le diagnostic de TFO pendant la grossesse. En cas de nécessité de réaliser une chirurgie d’une TFO en cours de grossesse, il n’existe pas d’arguments suffisants pour recommander une kystectomie ou une annexectomie. Pour les TFO, la voie cœlioscopique doit être privilégiée en cours de grossesse si elle est réalisable (grade C). La voie d’abord et le type de traitement chirurgical doivent être adaptés à la taille de la lésion, au terme obstétrical, et au désir ultérieur de grossesse, après avis de la RCP. En l’absence de données suffisantes dans la littérature, il n’est pas possible d’émettre de recommandations concernant la surveillance d’une suspicion de TFO non opérée présumée pendant la grossesse. Il n’existe pas suffisamment d’arguments dans la littérature pour modifier la prise en charge obstétricale en cas de TFO survenant au cours de la grossesse. En cas de stadification incomplète d’une TFO opérée en cours de grossesse, une chirurgie de restadification pourra être discutée selon les mêmes modalités qu’en dehors de la grossesse (grade C).
Le diagnostic de TFO survenant au cours de la grossesse reste rare malgré un dépistage systématique des masses annexielles au premier trimestre de la grossesse et l’avancée de l’âge maternel. Il existe peu de données dans la littérature concernant la prise en charge des TFO pendant la grossesse. L’ensemble des décisions doivent être prises après avis en RCP.
To determine the place of imaging, tumour markers, type of treatment and surgical route, follow-up, delivery mode, and re-staging in case of BOT during pregnancy, in order to provide guidelines.
A systematic bibliographical analysis on BOT during pregnancy was performed through a PUDMED search on articles published from 1990 to 2019 using keywords « borderline ovarian tumour and pregnancy ».
Pelvic ultrasound is the gold standard and first-line examination for the detection and characterization of adnexal masses during pregnancy (grade C). Pelvic MRI is recommended from 12 gestational weeks in case of indeterminate adnexal masses and should be concluded by a diagnostic score (grade C). Gadolinium injection should be minimized because of proven risk to the fetus and should be discussed on a case-by-case basis after patient information (grade C). In the absence of data in the literature, it is not possible to recommend the use of any tumour marker for the diagnosis of BOT during pregnancy. In case of a surgical treatment of BOT during pregnancy, there is insufficient evidence to recommend either a cystectomy or an oophorectomy. For BOT, the laparoscopic approach should be preferred during pregnancy if it is feasible (grade C). Surgical route and type of surgery should be chosen after taking into account the tumour size, the obstetrical term, and the subsequent desire for pregnancy, following discussion in a multidisciplinary meeting. In the absence of sufficient data in the literature, it is not possible to make any recommendation on the follow-up of a BOT suspected during pregnancy. There is not enough evidence in the literature to change obstetrical management for delivery in patients with BOT. In case of incomplete staging of a BOT treated during pregnancy, restaging can be discussed as for non-pregnant patients (grade C).
The diagnosis of BOT occurring during pregnancy remains rare despite systematic screening of adnexal masses in the first trimester of pregnancy and an increasing maternal age. There is limited data in the literature concerning the management of BOT during pregnancy. All decisions must be taken after discussion in a multidisciplinary meeting.
Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice – Therapeutic Management of Early Stages
2020, Gynecologie Obstetrique Fertilite et Senologie
Éditer, par le Collège national des gynécologues et obstétriciens français (CNGOF), des recommandations fondées sur les preuves disponibles dans la littérature pour la prise en charge des tumeurs frontières de l’ovaire (TFO) de stade précoce.
Recherche bibliographique en langue française et anglaise effectuée par consultation des bases de données Pubmed, Cochrane, Embase et des recommandations internationales.
Dans la prise en charge chirurgicale des TFO à un stade précoce, si une chirurgie sans risque de rupture tumorale avec extraction protégée des pièces opératoires est possible, la voie cœlioscopique est recommandée par rapport à la laparotomie (Grade C). Dans les TFO, il est recommandé de prendre toutes les dispositions pour éviter la rupture tumorale, y compris la décision peropératoire de laparoconversion (Grade C). Dans les TFO, une extraction de la pièce opératoire à l’aide d’un sac endoscopique est recommandée (Grade C). En cas de TFO de stade précoce, uni- ou bilatérale, suspectée à l’imagerie préopératoire chez une patiente ménopausée et/ou sans de désir de préservation de fertilité et/ou de la fonction endocrine, il est recommandé de réaliser une annexectomie bilatérale (Grade B). En cas de TFO de stade précoce séreuse bilatérale avec désir de préservation de la fertilité et/ou de la fonction endocrine, il est recommandé de réaliser une kystectomie bilatérale dans la mesure du possible (Grade B). En cas de TFO de stade précoce mucineuse avec désir de préservation de la fertilité et/ou de la fonction endocrine, il est recommandé de réaliser une annexectomie unilatérale (Grade C). En cas de TFO de stade précoce endométrioïde avec désir de préservation de la fertilité et/ou de la fonction endocrine, il n’est pas possible d’établir une recommandation de choix de traitement entre kystectomie et annexectomie unilatérale. En cas de TFO de stade précoce mucineuse à l’analyse histologique définitive chez une femme ayant eu une kystectomie initiale, avec ou sans désir de préservation de la fertilité et/ou de la fonction endocrine, une reprise chirurgicale pour une annexectomie unilatérale est recommandée (Grade C). En cas de TFO de stade précoce séreuse à l’analyse histologique définitive chez une femme ayant eu une kystectomie initiale, avec désir de préservation de la fertilité et/ou de la fonction endocrine, il n’est pas recommandé de reprise chirurgicale pour annexectomie en l’absence de lésion suspecte résiduelle lors de la chirurgie et/ou à l’imagerie postopératoire (échographie par référent ou IRM pelvienne) (Grade C). Une omentectomie est recommandée afin de réaliser une stadification initiale chirurgicale complète lorsqu’une TFO est diagnostiquée à l’examen extemporané ou suspectée sur les éléments radiologiques préopératoires (Grade B). Il n’existe pas de données dans la littérature permettant de recommander le type d’omentectomie à réaliser. Si une chirurgie de restadification est décidée pour une TFO à un stade présumé précoce, une omentectomie est recommandée (Grade B). Des biopsies péritonéales multiples sont recommandées afin de réaliser une stadification initiale chirurgicale complète lorsqu’une TFO est diagnostiquée à l’examen extemporané ou suspectée sur les éléments radiologiques préopératoires (Grade C). En cas de chirurgie de restadification pour une TFO à un stade présumé précoce, l’exploration de la cavité abdominale doit être complète et des biopsies péritonéales doivent être réalisées sur les zones suspectes ou de façon systématique (Grade C). Une cytologie péritonéale première est recommandée afin de réaliser une stadification initiale chirurgicale complète lorsqu’une TFO est suspectée sur les éléments radiologiques préopératoires (Grade C). En cas de chirurgie de restadification pour une TFO à un stade présumé précoce, une cytologie péritonéale première est recommandée (Grade C). Concernant les TFO séreuses ou mucineuses de stade précoce, il n’est pas recommandé de réaliser une hystérectomie à titre systématique (Grade C). Concernant les TFO de stade précoce de type endométrioïde, et en l’absence de désir de conserver la fertilité, il est recommandé de réaliser une hystérectomie en chirurgie initiale ou si une chirurgie de restadification est indiquée (Grade C). Concernant les TFO de stade précoce de type endométrioïde, en cas de désir de préservation de la fertilité, l’utérus peut être conservé sous réserve d’une bonne évaluation de l’endomètre par imagerie et prélèvement endométrial (Grade C). Concernant les TFO de stade précoce, quel que soit le type histologique, il est recommandé d’évaluer l’aspect macroscopique de l’appendice lors de la chirurgie (initiale ou de restadification si indiquée) (Grade B). Concernant les TFO de stade précoce, quel que soit le type histologique, il est recommandé de ne réaliser une appendicectomie qu’en cas d’aspect macroscopiquement pathologique de l’appendice (Grade C). Concernant les TFO de stade précoce, quel que soit le type histologique, la lymphadénectomie pelvienne et/ou lombo-aortique n’est pas recommandée dans le cadre d’une chirurgie initiale ou d’une chirurgie de restadification (Grade C). En cas de TFO diagnostiquée sur histologie définitive, l’indication de chirurgie de restadification doit être discutée en Réunion de Concertation Pluridisciplinaire. Pour les TFO présumées de stade précoce, il est recommandé de privilégier la voie cœlioscopique pour réaliser une chirurgie de restadification (Grade C). Une chirurgie de restadification est recommandée en cas de TFO séreuse avec aspect micropapillaire et une inspection de la cavité abdominale non satisfaisante lors de la chirurgie initiale (Grade C). Une chirurgie de restadification est recommandée en cas de TFO mucineuse si seule une kystectomie a été réalisée ou que l’appendice n’a pas été visualisé, il sera alors réalisé une annexectomie unilatérale (Grade C). Si une chirurgie de restadification est décidée dans la prise en charge d’une TFO présumée de stade précoce, les gestes à réaliser sont les suivants : une cytologie péritonéale (Grade C), une omentectomie (il n’existe pas de données dans la littérature permettant de recommander le type d’omentectomie à réaliser) (Grade B), une exploration complète de la cavité abdominale avec biopsies péritonéales sur les zones suspectes ou de façon systématique (Grade C), la visualisation de l’appendice ± l’appendicectomie en cas d’aspect macroscopique pathologique (Grade C), une annexectomie unilatérale en cas de TFO mucineuse (Grade C).
To provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning early stage borderline ovarian tumors (BOT).
Bibliographical search in French and English languages by consultation of Pubmed, Cochrane, Embase, and international databases.
Considering management of early stage BOT, if surgery is possible without a risk of tumor rupture, the laparoscopic approach is recommended compared to laparotomy (Grade C). In BOT, it is recommended to take all the measures to avoid tumor rupture, including the peroperative decision of laparoconversion (Grade C). In BOT, extraction of the surgical specimen using an endoscopic bag is recommended (Grade C). In case of early stage, uni or bilateral BOT, suspected in preoperative imaging in a postmenopausal patient, bilateral adnexectomy is recommended (Grade B). In cases of bilateral BOT and desire of fertility preservation, a bilateral cystectomy is recommended (Grade B). In case of mucinous BOT and desire of fertility preservation, it is recommended to perform a unilateral adnexectomy (Grade C). In case of endometrioid BOT and desire of fertility preservation, it is not possible to establish a recommendation of treatment choice between cystectomy and unilateral adnexectomy. In case of mucinous BOT at definitive histological analysis in a woman of childbearing age who had an initial cystectomy, surgical revision for unilateral adnexectomy is recommended (Grade C). In the case of serous BOT with definitive histological analysis in a woman of childbearing age who has had an initial cystectomy, it is not recommended to repeat surgery for adnexectomy in the absence of residual suspicious lesion during initial surgery and/or on postoperative imaging (referent ultrasound or pelvic MRI) (Grade C). An omentectomy is recommended for complete initial surgical staging when BOT is diagnosed on extemporaneous analysis or suspected on preoperative radiological elements (Grade B). There is no data in the literature to recommend the type of omentectomy to be performed. If restaging surgery is decided for a presumed early stage BOT, an omentectomy is recommended (Grade B). Multiple peritoneal biopsies are recommended for complete initial surgical staging when BOT is diagnosed on extemporaneous or suspected on preoperative radiological elements (Grade C). In case of restaging surgery for a presumed early stage BOT, exploration of the abdominal cavity should be complete and peritoneal biopsies should be performed on suspicious areas or systematically (Grade C). A primary peritoneal cytology is recommended in order to achieve complete initial surgical staging when BOT is suspected on preoperative radiological elements (Grade C). In case of restaging surgery for presumed early stage BOT, a first peritoneal cytology is recommended (Grade C). For early serous or mucinous BOT, it is not recommended to perform a systematic hysterectomy (Grade C). For early stage endometrioid BOT, and in the absence of a desire to maintain fertility, hysterectomy is recommended for initial surgery or if restaging surgery is indicated (Grade C). For endometrioid-type early stage BOT, if there is a desire for fertility preservation, the uterus may be retained subject to good evaluation of the endometrium by imaging and endometrial sampling (Grade C). In case of surgery (initial or restaging if indicated) for early stage BOT, it is recommended to evaluate the macroscopic appearance of the appendix (Grade B). In case of surgery (initial or restaging if indicated) for early stage BOT, appendectomy is recommended only in case of macroscopically pathological appearance of the appendix (Grade C). Pelvic and lumbar aortic lymphadenectomy is not recommended for initial surgery or restaging surgery for early stage BOT regardless of histologic type (Grade C). In case of BOT diagnosed on definitive histology, the indication of restaging surgery should be discussed in Multidisciplinary Collaborative Meeting. For presumed early stage BOT, it is recommended to use the laparoscopic approach to perform restaging surgery (Grade C). Restaging surgery is recommended for serous BOT with micropapillary appearance and unsatisfactory abdominal cavity inspection during initial surgery (Grade C). Restaging surgery is recommended in case of mucinous BOT if only a cystectomy has been performed or the appendix has not been visualized, then a unilateral adnexectomy will be performed (Grade C). If a restaging surgery is decided in the management of a presumed early stage BOT, the actions to be carried out are as follows: a peritoneal cytology (Grade C), an omentectomy (there is no data in the literature recommending the type of omentectomy to be performed) (Grade B), a complete exploration of the abdominal cavity with peritoneal biopsies on suspect areas or systematically (Grade C), visualization of the appendix ± the appendectomy in case of pathological macroscopic appearance (Grade C), unilateral adnexectomy in case of mucinous TFO (Grade C).

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The role of restaging borderline ovarian tumors: Single institution experience and review of the literature

Abstract

Background

Materials and methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Conflict of interest statement

Acknowledgment

Fertil Steril

Gynecol Oncol

Best Pract Res Clin Obstet Gynaecol

Hum Pathol

Gynecol Oncol

Gynecol Oncol

Gynecol Oncol

Gynecol Oncol

BJOG

Obstet Gynecol

Malignant and semimalignant tumors of the ovary

Surg Gynecol Obstet

International Federation of Gynecology and Obstetrics Classification and staging of malignant tumors in the female pelvis

Acta Obstet Gynecol Scand