Management of Borderline Ovarian Neoplasms

Abstract

Over the last decades, the management of borderline ovarian tumors (BOTs) has changed from radical surgery to more conservative therapy as a result of the need for fertility-sparing surgery and the increasing use of laparoscopy. The question is whether this is good clinical practice from an oncologic point of view. Here, recent literature regarding management of borderline ovarian neoplasms is reviewed, and oncologic concerns are discussed with emphasis on the mode of surgery and the possibility of fertility-sparing surgery and its consequences. Proper staging is defined as an exploration of the entire abdominal cavity with peritoneal washings, infracolic omentectomy, and multiple peritoneal biopsies as the cornerstone of a successful treatment, and this is only possible through a midline incision. For stage I disease, conservative surgery consisting of unilateral salpingo-oophorectomy or cystectomy in case of bilateral ovarian involvement or when the disease develops in the only remaining ovary is a valuable alternative in a number of young patients who want to preserve their fertility. Patients with advanced-stage disease or who are finished childbearing are treated with radical surgery consisting of peritoneal washings, total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, complete peritoneal resection of macroscopic lesions, or multiple peritoneal biopsies; in case of mucinous BOTs, patients also are treated with an appendectomy.

Clinical management of borderline tumours of the ovary: results of a multicentre survey of 323 clinics in Germany

“…For serous tumours, approximately 40% (range 28 -66%), and for mucinous tumours, about 8% (range 0 -13%) of the BOTs are observed to be bilateral Cadron et al, 2007;Kumpulainen et al, 2007). In this context, we observed that 19% of the clinical participants performed only unilateral ovarian cystectomy or at least USO.…”

“…Despite this fact, a removal of enlarged lymph nodes, so called 'bulky nodes', can be performed. In contrast to an ovarian carcinoma, invasion in the lymph nodes and metastatic spread of BOT are quite seldom and usually noninvasive (Hart, 2005;Cadron et al, 2007;Kumpulainen et al, 2007). Moreover, it is not yet clear whether these lymph node implantations represent real metastases, in situ transformed secondary muellerian epithelia or hyperplastic mesothelial cells (Shiraki et al, 1992;Chang et al, 2008).…”

“…The therapy of BOT leans closely on the clinical management of ovarian carcinoma and is directed at definitive staging, that is complete or maximum tumour debulking, although the treatment of BOTs does show some relevant differences (Cadron et al, 2007;Schmalfeldt and Pfisterer, 2007). According to the FIGO classification, the state-of-the-art surgical treatment includes a detailed exploration of the entire abdomen, bilateral salpingo-oophorectomy (BSO), hysterectomy, omentectomy, peritoneal lavage (or ascites sample) and peritoneal biopsies and resection of all suspected lesions (Trope et al, 2000;Schmalfeldt and Pfisterer, 2007).…”

“…According to the FIGO classification, the state-of-the-art surgical treatment includes a detailed exploration of the entire abdomen, bilateral salpingo-oophorectomy (BSO), hysterectomy, omentectomy, peritoneal lavage (or ascites sample) and peritoneal biopsies and resection of all suspected lesions (Trope et al, 2000;Schmalfeldt and Pfisterer, 2007). For mucinous tumours, an appendectomy should be performed to exclude any ovarian metastasis of possible mucinous tumour of the appendix (Lichtenegger et al, 1998;Cadron et al, 2007;Schmalfeldt and Pfisterer, 2007).…”

“…Although most part of BOT therapy was strongly oriented towards the ovarian cancer treatment (Suh-Burgmann, 2006;Tinelli et al, 2006;Cadron et al, 2007), adjuvant systemic chemotherapy is nowadays not generally indicated (Boran et al, 2005;Sehouli et al, 2005a, b;Romagnolo et al, 2006;Wong et al, 2007;Yinon et al, 2007).…”