Management of  Borderline Ovarian Tumours: A comprehensive Review of Published Evidence 

Borderline Ovarian Tumours (BOTs) comprise 15-20% of all epithelial ovarian tumours. BOTs are characterised by increased mitotic activity but lack infiltrative destructive growth and stromal invasion (1). With an incidence of 1.8-4.8 per 100,000  they can affect one third of pre-menopausal women (2). The disease carries an excellent prognosis for the majority of patients albeit  consensus regarding  aspects of BOT management has not been reached.

Non-consensus in BOT management was reviewed in literature including approach (radical versus fertility-sparing surgery); route (open v laparoscopic surgery); disease recurrence; follow-up protocols and modalities (imaging, serum biomarkers); role of completion surgery;  lymph node dissection during staging, or adjuvant chemotherapy; as well as use of Hormone- Replacement Therapy (HRT) post-surgery (Figure A). 

We performed a structured narrative review on Medline, EMBASE and Cochrane Library Databases to identify studies pertaining to the management of BOTs as well as guidance from international societies, including but not limited to the Federation of Gynaecology & Obstetrics; European Society of Gynaecological Oncology; British Gynaecological Cancer Society. Guidance was summarised on the route of surgery, recurrence rates and prognosis, follow-up and role of serum
biomarkers for surveillance, completion surgery, role of lymphadenectomy, role of chemotherapy, use of hormone replacement therapy and novel approaches to BOT management (3-7) (Figure B).

There were areas of general consensus surrounding BOT management. Generally, BOTs are associated with a very good prognosis. Fertility-sparing options  for younger women are safe albeit carry a higher risk of recurrence which must be communicated to patients (Figure C).Laparoscopic surgery where technically possible is feasible and subsequent radical surgery may be performed as a second stage albeit there is no prognostic benefit to hysterectomy. Advanced disease is best  managed at specialist centres and adjuvant chemotherapy and lymphadenectomy have shown to have a menial role in  BOT treatment. Areas of disagreement include the modality and length of follow-up of patients after surgery  as well as the  use of serum biomarkers  in prognosis and the role  of hormone replacement (Figure D).

To our knowledge this is the first review to summarise current consensus on management and follow-up of BOTs. Further  research into the molecular profile of BOT’s; identifying novel biomarkers linked with recurrence and development of risk prediction models for  recurrence would aid standardising  the patient follow-up process (Figure D).Moreover, prospective trials evaluating quality of life after BOT treatment  and use of therapies such as HRT are necessary to  optimise safety  and patient outcomes.