title: Surgical management and perioperative morbidity of patients with primary borderline ovarian tumor (BOT).
abstract: BACKGROUND
  Surgery is the cornerstone for clinical management of patients with borderline ovarian tumors (BOT). As these patients have an excellent overall prognosis, perioperative morbidity is the critical point for decision making when the treatment strategy is developed and the primary surgical approach is defined.
  
  
  METHODS
  Clinical and surgical parameters of patients undergoing surgery for primary BOT at our institutions between 1993 and 2008 were analyzed with regard to perioperative morbidity depending on the surgical approach (laparotomy vs. laparoscopy).
  
  
  RESULTS
  A total of 105 patients were analyzed (44 with primary laparoscopy [42%], 61 with primary laparotomy [58%]). Complete surgical staging was achieved in 33 patients at primary surgical approach (31.4%) frequently leading to formal indication of re-staging procedures. Tumor rupture was significantly more frequent during laparoscopy compared to laparotomy (29.5% vs. 13.1%, p = 0.038) but no other intraoperative complications were seen in laparoscopic surgery in contrast to 7 of 61 laparotomies (0% vs. 11.5%, p = 0.020). Postoperative complication rates were similar in both groups (19.7% vs. 18.2%, p = 0.848).
  
  
  CONCLUSIONS
  Irrespective of the surgical approach, surgical management of BOT has acceptable rates of perioperative complications and morbidity. Choice of initial surgical approach can therefore be made independent of complication-concerns. As the recently published large retrospective AGO ROBOT study observed similar oncologic outcome for both approaches, laparoscopy can be considered for staging of patients with BOT if this appears feasible. An algorithm for the surgical management of BOT patients has been developed.
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. s.mahner@uke.uni-hamburg.de.
authors.forename: Fabian
authors.initials: F
authors.lastname: Trillsch
authors.forename: Jan David
authors.initials: JD
authors.lastname: Ruetzel
authors.forename: Uwe
authors.initials: U
authors.lastname: Herwig
authors.forename: Ulrike
authors.initials: U
authors.lastname: Doerste
authors.forename: Linn
authors.initials: L
authors.lastname: Woelber
authors.forename: Donata
authors.initials: D
authors.lastname: Grimm
authors.forename: Matthias
authors.initials: M
authors.lastname: Choschzick
authors.forename: Fritz
authors.initials: F
authors.lastname: Jaenicke
authors.forename: Sven
authors.initials: S
authors.lastname: Mahner