Salpingo-oophorectomy versus cystectomy in patients with borderline ovarian tumors: a systemic review and meta-analysis on postoperative recurrence and fertility

Abstract

Background To compare the postoperative recurrence and fertility in patients with borderline ovarian tumors (BOTs) who underwent different surgical procedures: salpingo-oophorectomy versus cystectomy. Methods Potentially relevant literature from inception to Nov. 06, 2020, were retrieved in databases including Cochrane Library, EMBASE (Ovid), and MEDLINE (Pubmed). We applied the keywords “fertility-sparing surgery,” or “conservative surgery,” or “cystectomy,” or “salpingo-oophorectomy,” or “oophorectomy,” or “adnexectomy,” or “borderline ovarian tumor” for literate searching. Systemic reviews and meta-analyses were performed on the postoperative recurrence rates and pregnancy rates between patients receiving the two different surgical methods. Begger’s methods, Egger’s methods, and funnel plot were used to evaluate the publication bias. Result Among the sixteen eligible studies, the risk of recurrence was evaluated in all studies, and eight studies assessed the postoperative pregnancy rates in the BOT patients. A total of 1839 cases with borderline ovarian tumors were included, in which 697 patients (37.9%) received unilateral salpingo-oophorectomy and 1142 patients (62.1%) underwent unilateral/bilateral cystectomy. Meta-analyses showed that BOT patients with unilateral/bilateral cystectomy had significantly higher recurrence risk (OR=2.02, 95% CI: 1.59-2.57) compared with those receiving unilateral salpingo-oophorectomy. Pooled analysis of four studies further confirmed the higher risk of recurrence in patients with cystectomy (HR=2.00, 95% CI: 1.11-3.58). In addition, no significant difference in postoperative pregnancy rate was found between patients with the two different surgical procedures (OR=0.92, 95% CI: 0.60-1.42). Conclusion Compared with the unilateral/bilateral cystectomy, the unilateral salpingo-oophorectomy significantly reduces the risk of postoperative recurrence in patients with BOT, and it does not reduce the pregnancy of patients after surgery. Trial registration PROSPERO CRD42021238177

Fertility-sparing surgery in children and adolescents with borderline ovarian tumors: a retrospective study

“…However, recurrence rates are elevated subsequent to UC in comparison to USO in our results, especially in the subgroup of MBOTs ( p < 0.05). A meta-analysis confirmed that cystectomy was associated with a higher recurrence rate of BOTs but no impact on the postoperative pregnancy rate [ 30 ]. MBOTs tend to be large and unilateral and contain multiple cystic spaces of varying sizes which may increase surgical difficulty and the risk of intraoperative rupture.…”

Tumor ovárico <i>borderline</i> en paciente pediátrico. Reporte de caso

“…En cuanto al manejo quirúrgico, la cirugía preservadora de fertilidad consiste en realizar salpingooforectomía unilateral o cistectomía en estadios tempranos del tumor 18 , sin embargo existe controversia en cuanto al manejo adecuado, pues se ha descrito que la cistectomía aumenta la recurrencia del tumor aproximadamente a un 33.5% a 10 años, mientras que con la cirugía radical la recurrencia es del 12%. No se ha mostrado diferencia en la tasa de embarazo entre estos dos procedimientos 19 .…”

Characteristics of Endometrioma Recurrence Patients

“…1 Cystectomy and salpingo-ophorectomy belong to Fertility-Sparing Treatment (FST). 14 Thus, this type of surgery is chosen as one of endometrioma treatment. However, surgical procedure still effects ovarian reserve, though there still a chance of pregnancy.…”