The impact of hysterectomy on oncological outcomes in patients with bor

Available online 26 January 2022

Highlights

•: Surgical management of BOT can range from unilateral cystectomy to a more extensive surgical staging
•: The role of hysterectomy within the surgical staging of BOT is still debated
•: This may be the first systematic review and meta-analysis in the field
•: Uterine-sparing surgery seems to increase the risk of recurrence, but not those of death due to disease or death of any cause
•: Uterine-sparing surgery might be recommended in all BOT patients

Abstract

Background

Surgical management of Borderline ovarian tumors (BOT) can range from unilateral cystectomy to a more extensive surgical staging. However, the role of hysterectomy within the surgical staging is still debated.

Aim

To assess the impact of hysterectomy on survival outcomes in BOT patients.

Materials and methods

5 electronic databases were searched from their inception to April 2021 for all peer-reviewed, retrospective or prospective studies, which compared treatment including hysterectomy versus treatment not including hysterectomy for BOT, in terms of recurrence and/or death. Pooled odds ratios (OR) with 95% confidence interval for recurrence, death due to BOT and death of any cause were calculated comparing hysterectomy group versus no hysterectomy group. Subgroup analyses for recurrence were based on BOT histotype (mucinous and serous) and FIGO stage (I and II-III).

Results

Twelve studies assessing 2223 patients were included. Compared to no hysterectomy group, hysterectomy group showed an OR of 0.23 (p = 0.00001) for recurrence, 1.26 (p = 0.77) for death due to BOT and 4.23 (p = 0.11) for death of any cause. At subgroup analyses, compared to no hysterectomy group, hysterectomy group showed an OR for recurrence of 0.21 (p = 0.003) in serous subgroup, of 0.46 (p = 0.18) in mucinous subgroup, of 0.23 (p = 0.0006) in FIGO stage I subgroup, and of 0.29 (p = 0.04) in FIGO stage II-III subgroup.

Conclusions

Uterine-sparing surgery might be recommended in all BOT patients since it seems to increase the risk of recurrence, but not those of death due to disease or death of any cause.

Keywords

Cancer

Fertility-sparing

Uterus

Tumors

Carcinoma

Salpingo-oophorectomy

Omentectomy

Mortality

Morbidity

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