A Meta-analysis Of The Feasibility Of Preserving Fertility And Risk Factors For Recurrence Of Borderline Ovarian Tumors

Objective:To evaluate the feasibility of fertility-sparing surgery(FSS)and analyze prognostic factors in patients with borderline ovarian tumors(BOTs)..Methods:Literatures about fertility-sparing surgery(FSS)for BOTs were searched in English and Chinese databases including PubMed,The Cochrane Library,Medline,CNKI,VIP and Wanfang from January,2010 to August,2019.Data extraction and quality assessment were done by using the stata12.0 Meta-analysis software.Results:(1)Twenty-three cohort studies met selection criteria including a total of 4546 patients(2204 cases treated with FSS and 2342 cases with radical surgery).Compared with radical surgery,the recurrence of the fertility-sparing surgery was higher significantly(OR=3.05,95%CI:2.46-3.77,P=0.000).(2)The survival rate after initial treatment was obtained in 12 cohort studies including 2319 cases(1089 cases of FSS and 1230 cases of radical surgery).There was no significant difference in the survival rate between the two groups(HR=0.98,95%CI:0.98-1.08).(3)The fertility results were obtained in 6 relevant studies.30 patients achieved pregnancies in a total of 40 patients attempting to conceive with a pregnant rate of 75%.24 full-term deliveries were achieved in 26 patients,with a full-term delivery rate of 75%.(4)Recurrent risks in patients with serous BOTs(OR=2.61,95%CI:1.86-3.64),bilateral ovarian tumors(OR=2.61,95%CI:1.86-3.64),cystectomy instead of oophorectomy(OR=2.23,95%CI:1.32-3.76),non-complete staging surgery(OR=1.79,95%CI:1.34-2.36)and laparoscopic surgery(OR=1.44,95%CI:1.02-2.05)were significantly increased.However,the recurrent risk was not higher in patients who didn't receive lymphadenectomy(OR=0.98,95%CI:0.59-1.60).Conclusions:In spite of a higher recurrent rate,fertility-sparing surgery in BOTs patients was practicable and safe with ideal pregnant outcomes and unimpaired survival rate.Recurrent risks of BOTs patients included serous BOTs,bilateral ovarian tumors,cystectomy surgery,incomplete staging surgery and laparoscopic surgery.