Feasibility, safety, and efficacy of conservative laparoscopic treatment of borderline ovarian tumors

Objective: To outline the most recent information regarding conservative laparoscopic surgery for young women with borderline ovarian tumors. Design: Review article. Setting: Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy. Patient(s): Young women with low-stage borderline ovarian tumors who wish to preserve their fertility. Intervention(s): Conservative laparoscopic surgery with unilateral salpingo-oophorectomy or cystectomy. Main Outcome Measure(s): Recurrence rate and outcomes. Result(s): Laparoscopic cystectomy may have more chance of preserving a woman's fertility compared with adnexectomy because of the removal of less ovarian tissue. Its greatest danger is the risk of inadvertently leaving behind some malignant cells. Therefore, this procedure should be reserved for patients with previous unilateral salpingo-oophorectomy or when bilateral lesions are present to preserve at least some ovarian tissue. Conclusion(s): When borderline ovarian tumors are identified at surgery by intraoperative histology, the recommended conservative treatment should be laparoscopic salpingo-oophorectomy. Recurrence can be noted after this type of treatment, but the cases of recurrent disease can be detected with close follow-up and treated accordingly. For these reasons, careful selection of candidates for this kind of treatment is, of course, necessary and close follow-up is required. If these restrictions are rigorously applied, then fertility-sparing surgery may be considered a safe option for this pathology, but all laparoscopic procedures should be reserved for oncologic surgeons trained in extensive laparoscopic procedures. (Fertil Steril (R) 2009;92:736-41. (C)2009 by American Society for Reproductive Medicine.)