The thesis of Koen de Decker was aimed at exploring and optimizing therapeutic strategies for borderline ovarian tumors and low-grade serous ovarian cancer. Based on our study and a thorough review of the existing literature, it can be concluded that mucinous borderline ovarian tumors very rarely present with extraovarian disease. Surgical staging procedures, with the aim of detecting extraovarian disease, can be omitted safely without compromising progression-free and overall survival rates. Omission of a staging procedure implicates less comprehensive surgery and decreased surgical morbidity, which is beneficial to the patient.
Provisional diagnoses of borderline ovarian tumors are often made intraoperatively using the frozen section technique. However, it is not always possible to report a frozen section diagnosis as a borderline ovarian tumor or an invasive carcinoma and we showed that one fourth of borderline ovarian tumor diagnoses are classified as “at least borderline” upon frozen section evaluation. Nearly half of these patients had ovarian cancer as a final diagnosis. Because surgical management is based upon the frozen section result, and is different for borderline tumors and ovarian cancer, this is a dilemma for both the surgeon and pathologist.
The main findings with respect to low-grade serous carcinoma in The Netherlands (2000–2019) were increased annual incidence rates, increased numbers of patients with advanced stage disease, prognostic significance of the extent to which the disease could be removed during surgery, and overall relative survival rates that did not significantly change over time. Furthermore, an increasing percentage of patients started treatment with neoadjuvant chemotherapy, which is associated with worse survival compared to starting treatment with a surgical procedure.
