Fertility-sparing surgery and reproductive-outcomes in patie
Key points:

-Fertility sparing surgery has become increasingly an important issue in patients with Borderline ovarian tumors.

-Fertility sparing surgery in FIGO stage I is a safe procedure and were classified a low-risk category.

-In higher FIGO stages FSS has to be discussed individually.

-Life-birth-rates after FSS in patients with BOT are high.

-A central review of pathology is mandatory and may have contributed to our low rate of invasive relapses.

Borderline ovarian tumors (BOT) are considered a biological category with increased epithelial proliferation and cellular atypia in the absence of invasive growth. Since BOT occur often in young patients fertility-sparing surgery (FSS) is an important issue. With this study aimed to evaluate risk factors for relapses and fertility of patients after FSS.

Among 352 Patients 80.2% had FIGO I and 63.9% had a serous BOT. Eighteen patients relapsed and 4 cases of malignant transformation were reported. One patient of the latter died, all others have no evidence of disease. The overall recurrence rate was 1.1% in FIGO-Stage I and 25.5% in FIGO III-IV. 95 patients underwent FSS. Thirteen of these patients relapsed, all as BOT. In multivariate analysis FIGO stages II-IV and FSS remained significant risk factors for recurrent disease. Pregnancy rate among forty-one patients attempting to conceive was 82.9%. 29 patients experienced at least one life-birth, in total 38 life-births were reported.

The result of analysis contains two different massages: first that FSS in FIGO stage I is a safe procedure and is very likely to result in future pregnancies. In all other stages FSS has to be discussed individually and second, an external second opinion regarding pathology is mandatory to avoid unnecessary under- or overtreatment.