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Original Research

Open Access

Exploring the impact of surgical interventions and identifying risk factors for recurrence in stage I of borderline ovarian tumors

  • Seon-Mi Lee1
  • Sanghoon Lee1,*,
  • Jae-Yun Song1
  • Aeran Seol1
  • Hyun-Woong Cho2
  • Kyung-Jin Min3
  • Jin-Hwa Hong2
  • Jae-Kwan Lee2
  • Nak-Woo Lee3

1Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, 02841 Seoul, Republic of Korea

2Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Guro Hospital, 08308 Seoul, Republic of Korea

3Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Ansan Hospital, 15355 Ansan, Republic of Korea

DOI: 10.22514/ejgo.2024.030 Vol.45,Issue 2,April 2024 pp.75-87

Submitted: 25 July 2023 Accepted: 25 August 2023

Published: 15 April 2024

*Corresponding Author(s): Sanghoon Lee E-mail:


This research aimed to evaluate surgical intervention’s influence on borderline ovarian tumors (BOTs) outcomes and identify contributing recurrence risk factors. BOT patients at Korea University Anam Hospital (2006–2023) were classified based on recurrence. Surgical interventions were classified conservative, comprehensive or staging surgeries. Each group’s characteristics, surgical interventions, disease-free survival (DFS), overall survival (OS), and recurrence risk factors were compared and analyzed. Statistical analyses included student’s t-test, chi-square test, Fisher’s exact test, Kaplan-Meier analysis, and Cox regression analyzing using SPSS. Of 177 patients, 170 were in the no recurrence group, and seven were in the recurrence group. Four relapsed patients had a borderline recurrence, and three had a malignant transformation. The median follow-up period for all participants was 47 months. There were no significant differences in DFS and OS on surgical interventions. Increased risk of BOT recurrence was observed with positive washing cytology (adjusted hazard ratio (HR), 36.02; 95% confidence interval (CI), 6.798, 641.204; p = 0.003) and intraoperative iatrogenic rupture (adjusted HR, 5.89; 95% CI, 1.003, 27.640; p = 0.046), but no significant OS risk factors were identified. In early stage BOT treatment, surgical intervention differences didn’t affect outcomes, DFS or OS. Conservative, comprehensive and staging surgeries are options based on patient age and fertility preservation. To reduce BOT recurrence risk, avoiding rupture during surgery and closely monitoring postoperative patient with positive washing cytology is crucial.


Borderline ovarian tumors; Conservative surgery; Comprehensive surgery; Staging surgery; Recurrence; Risk factors

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Seon-Mi Lee,Sanghoon Lee,Jae-Yun Song,Aeran Seol,Hyun-Woong Cho,Kyung-Jin Min,Jin-Hwa Hong,Jae-Kwan Lee,Nak-Woo Lee. Exploring the impact of surgical interventions and identifying risk factors for recurrence in stage I of borderline ovarian tumors. European Journal of Gynaecological Oncology. 2024. 45(2);75-87.


[1] Jenna F. What to know about borderline ovarian tumors. 2022. Available at: (Accessed: 18 April 2023).

[2] Koensgen D, Weiss M, Assmann K, Brucker SY, Wallwiener D, Stope MB, et al. Characterization and management of borderline ovarian tumors—results of a retrospective, single-center study of patients treated at the department of gynecology and obstetrics of the university medicine Greifswald. Anticancer Research. 2018; 38: 1539–1545.

[3] Kipp B, Vidal A, Lenick D, Christmann-Schmid C. Management of Borderline ovarian tumors (BOT): results of a retrospective, single center study in Switzerland. Journal of Ovarian Research. 2023; 16: 20.

[4] Ouh Y-T, Kang D, Kim H, Lee JK, Hong JH. Nationwide population-based study of prevalence and trend of borderline ovarian tumors in the Republic of Korea. Scientific Reports. 2021; 11: 11158.

[5] du Bois A, Ewald-Riegler N, de Gregorio N, Reuss A, Mahner S, Fotopoulou C, et al. Borderline tumours of the ovary: a cohort study of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) study group. European Journal of Cancer. 2013; 49: 1905–1914.

[6] Nougaret S, Lakhman Y, Molinari N, Feier D, Scelzo C, Vargas HA, et al. CT features of ovarian tumors: defining key differences between serous borderline tumors and low-grade serous carcinomas. American Journal of Roentgenology. 2018; 210: 918–926.

[7] Fischerova D, Zikan M, Dundr P, Cibula D. Diagnosis, treatment, and follow-up of borderline ovarian tumors. The Oncologist. 2012; 17: 1515–1533.

[8] May J, Skorupskaite K, Congiu M, Ghaoui N, Walker GA, Fegan S, et al. Borderline ovarian tumors: fifteen years’ experience at a Scottish tertiary cancer center. International Journal of Gynecologic Cancer. 2018; 28: 1683–1691.

[9] Sozen H, Vatansever D, Topuz S, Iyibozkurt C, Kandemir H, Yalçin I, et al. Clinicopathological analysis of borderline ovarian tumours and risk factors related to recurrence: experience of single institution. Journal of Obstetrics and Gynaecology. 2019; 39: 253–258.

[10] NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Ovarian cancer. National Comprehensive Cancer Network. 2013; 12. Available at: (Accessed: 18 April 2023).

[11] Kim S, Min KJ, Lee S, Hong JH, Song JY, Lee JK, et al. Is ovarian cystectomy feasible for patients with borderline ovarian tumors? a retrospective study and review of the literature. Clinical and Experimental Obstetrics & Gynecology. 2022; 49: 51.

[12] Plett H, Harter P, Ataseven B, Heitz F, Prader S, Schneider S, et al. Fertility-sparing surgery and reproductive-outcomes in patients with borderline ovarian tumors. Gynecologic Oncology. 2020; 157: 411–417.

[13] Trillsch F, Mahner S, Woelber L, Vettorazzi E, Reuss A, Ewald-Riegler N, et al. Age-dependent differences in borderline ovarian tumours (BOT) regarding clinical characteristics and outcome: results from a sub-analysis of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) ROBOT study. Annals of Oncology. 2014; 25: 1320–1327.

[14] Delle Marchette M, Ceppi L, Andreano A, Bonazzi CM, Buda A, Grassi T, et al. Oncologic and fertility impact of surgical approach for borderline ovarian tumours treated with fertility sparing surgery. European Journal of Cancer. 2019; 111: 61–68.

[15] Oh S, Kim R, Lee Y, Kim JW, Park N, Song Y. Clinicopathological aspects of patients with recurrence of borderline ovarian tumors. Obstetrics & Gynecology Science. 2015; 58: 98.

[16] Tsai H, Ko C, Yeh C, Chen Y, Twu N, Chao K, et al. Unilateral salpingo-oophorectomy as fertility-sparing surgery for borderline ovarian tumors. Journal of the Chinese Medical Association. 2011; 74: 250–254.

[17] Cadron I, Leunen K, Van Gorp T, Amant F, Neven P, Vergote I. Management of borderline ovarian neoplasms. Journal of Clinical Oncology. 2007; 25: 2928–2937.

[18] Helpman L, Yaniv A, Beiner ME, Aviel-Ronen S, Perri T, Ben-Baruch G, et al. Fertility preservation in women with borderline ovarian tumors—how does it impact disease outcome? A cohort study. Nordic Federation of Societies of Obstetrics and Gynecology. 2017; 96: 1300–1306.

[19] Ifthikar MA, Rajanbabu A, Nair IR, Murali V, Nair AS. Retrospective analysis of factors affecting recurrence in borderline ovarian tumors. South Asian Journal of Cancer. 2020; 09: 168–173.

[20] Li Y, Kong Q, Wei H, Wang Y. Comparison of the complications between minimally invasive surgery and open surgical treatments for early-stage cervical cancer: a systematic review and meta-analysis. PLOS ONE. 2021; 16: e0253143.

[21] Seracchioli R, Venturoli S, Colombo FM, Govoni F, Missiroli S, Bagnoli A. Fertility and tumor recurrence rate after conservative laparoscopic management of young women with early-stage borderline ovarian tumors. Fertility and Sterility. 2001; 76: 999–1004.

[22] Romagnolo C, Gadducci A, Sartori E, Zola P, Maggino T. Management of borderline ovarian tumors: results of an Italian multicenter study. Gynecologic Oncology. 2006; 101: 255–260.

[23] Casarin J, Laganà AS, Uccella S, Cromi A, Pinelli C, Gisone B, et al. Surgical treatment of large adnexal masses: a retrospective analysis of 330 consecutive cases. Minimally Invasive Therapy & Allied Technologies. 2020; 29: 366–374.

[24] Fauvet R, Boccara J, Dufournet C, Poncelet C, Daraï E. Laparoscopic management of borderline ovarian tumors: results of a French multicenter study. Annals of Oncology. 2005; 16: 403–410.

[25] Lee J, Kim HJ, Heo Y, Lee HJ. Effect of within-endobag method during laparoscopic ovarian cystectomy of dermoid cyst: a retrospective study. Medicine. 2023; 102: e33043.

[26] Vergote I, De Brabanter J, Fyles A, Bertelsen K, Einhorn N, Sevelda P, et al. Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. The Lancet. 2001; 357: 176–182.

[27] Bohara S, Jain S, Khurana N, Shangpliang D, Agarwal S, Gandhi G. Intraoperative cytology of ovarian neoplasms with an attempt to grade epithelial tumors. Journal of Cytology. 2018; 35: 1–7.

[28] Naz S, Hashmi AA, Ali R, Faridi N, Hussian SD, Edhi MM, et al. Role of peritoneal washing cytology in ovarian malignancies: correlation with histopathological parameters. World Journal of Surgical Oncology. 2015; 13: 315.

[29] Song T, Lee Y, Choi CH, Kim T, Lee J, Bae D, et al. Borderline ovarian tumor in women aged ≥65 years: impact on recurrence and survival. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2015; 184: 38–42.

[30] Vancraeynest E, Moerman P, Leunen K, Amant F, Neven P, Vergote I. Fertility preservation is safe for serous borderline ovarian tumors. International Journal of Gynecologic Cancer. 2016; 26: 1399–1406.

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