Laparoscopic Staging of Borderline Ovarian Tumors A Fertility Conscious Approach to Precision Surgery

Introduction:

Borderline Ovarian Tumors (BOTs) represent a unique clinical entity often diagnosed in women of reproductive age. With fertility preservation becoming a significant concern, laparoscopic staging is gaining ground as a preferred treatment strategy. This technique not only offers diagnostic clarity but also balances oncological safety with reproductive goals.
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Understanding Borderline Ovarian Tumors

• Typically diagnosed in women around age 40
• Histologically distinct from benign and malignant tumors
• Often present with symptoms similar to other adnexal masses: pelvic pain, irregular menses, and abdominal pressure
• Found unilaterally in most cases, though 30% of serous types appear bilaterally

Laparoscopic Staging: Technique and Considerations

• Preoperative Assessment:
  BOT diagnosis begins with pelvic imaging (TVS or MRI), CA 125 biomarker evaluation, and thorough medical history.
• Surgical Approach:
  • Conservative (for fertility preservation): unilateral salpingo-oophorectomy or cystectomy
  • Radical: Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH + BSO) with omentectomy and biopsies
  • Omentectomy technique involves infracolic resection preserving gastroepiploic vessels
• Frozen Section Evaluation:
  Guides intraoperative decisions; crucial for differentiating BOTs from invasive tumors

External Medical Reference Integration

The American College of Obstetricians and Gynecologists (ACOG) highlights that minimally invasive approaches like laparoscopy improve recovery outcomes, provided they are executed by skilled surgeons and followed by appropriate staging protocols.

Fertility Preservation Insights

• BOT patients desiring fertility should be counseled on options such as oocyte/embryo freezing.
• Conservative surgery is viable even in bilateral involvement, but it demands careful follow-up.
• Post-surgical conception is encouraged sooner to reduce recurrence-related complications.

Key Surgical Criteria and Outcomes

• Tumor Size: Lesions >8 cm correlate with higher malignancy risk
• Histologic Subtype: Micropapillary, endometrioid, and clear cell patterns require aggressive staging
• Recurrence Risk: Higher with cystectomy vs. salpingo-oophorectomy
• Lymphadenectomy: Generally not necessary; contributes minimally to prognosis

Further Reading and Resources

Read the full study at:
https://doi.org/10.29328/journal.cjog.1001081

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