Fertility sparing surgery in patients with advanced borderline ovarian tumors: Oncologic outcomes of a single-institution cohort

Introduction: The purpose of this single-center retrospective analysis is to evaluate the long-term feasibility and oncologic safety of fertility-sparing surgery (FSS) in patients with advanced borderline ovarian tumors (BOTs). Methods: Patients with FIGO stage IIA-IIIC BOTs treated with FSS between 1985 and 2021 were evaluated. Results: A total of 86 patients were included, the majority having serous histology (90.7 %), bilateral ovarian involvement (61.6 %), and stage III disease (54.6 %) with non-invasive implants (80.2 %). The most common surgical approach was unilateral adnexectomy with/without contralateral cystectomy (58.1 %) After a median follow-up of 182 months, 66 patients (76,7 %) experienced recurrence, with a median RFS of 148 months; among them, 36 relapsed more than once. Most patients experienced isolated ovarian recurrence at both first (69.7 %) and second relapse (60.0 %); in these patients, a rechallenge with FSS was offered in most cases, whereas radical surgery was preferred (53.3 %) at third recurrence. Three patients with recurrent disease developed invasive low-grade serous ovarian carcinoma (LGSOC). At univariable analysis, the laterality of ovarian involvement (p = 0.027) and the type of adnexal procedure (p = 0.019) were significant predictors of recurrence. At last follow-up 83 patients (96.5 %) were alive without evidence of disease, 2 patients (2.3 %) were alive with persistent/recurrent disease and death occurred in only one patient (1.2 %). Conclusions: Despite the high recurrence rate, our series demonstrates that FSS has excellent oncologic outcomes in managing advanced BOTs. Therefore, fertility preservation is advised in young women with advanced BOTs who have not yet fulfilled their desire for childbearing.