What is the risk of recurrence of a benign serous ovarian cystadenoma after cystectomy?

Risk of Recurrence of Benign Serous Ovarian Cystadenoma After Cystectomy

Cystectomy for benign serous ovarian cystadenomas carries an increased risk of recurrence compared to more extensive surgical approaches, with recurrence rates estimated at 8-10% in the ipsilateral ovary.

Recurrence Risk Factors and Rates

• Cystectomy (particularly compared to adnexectomy) increases the risk of recurrence in serous ovarian tumors 1
• A meta-analysis and large multi-center German study demonstrated that ultraconservative surgery (cystectomy) increases recurrence risk in serous borderline ovarian tumors 1
• For serous borderline ovarian tumors (sBOTs) with stage I disease, the risk of ipsilateral persistence or recurrence per ovary after cystectomy is approximately 8% 2
• Recurrence risk is higher when:
  • Tumor involves the resection margin of the cystectomy specimen 2
  • Multiple cysts are removed from the same ovary 2
  • Incomplete staging is performed 1

Timing of Recurrence

• Recurrences may occur early (within months) or many years after the initial surgery 3, 4
• In one study of serous borderline tumors with noninvasive implants:
  • Only 10% of recurrences occurred within 5 years
  • 19% occurred between 5-10 years
  • 10% occurred between 10-15 years
  • 5% occurred more than 15 years after primary surgery 3
• Some case reports document recurrence as early as 2 months after initial cystectomy 4

Risk of Malignant Transformation

• The risk of invasive recurrence after fertility-sparing surgery for borderline tumors is very low but exists, estimated at 0.5% 1
• Most recurrences of serous borderline tumors are borderline in nature rather than invasive carcinomas, which has favorable implications for patient outcomes 1

Management Considerations

• Despite the increased recurrence risk with cystectomy, this approach is considered acceptable for serous borderline ovarian tumors (sBOTs) to preserve fertility 1
  • The European Society for Medical Oncology (ESMO) and European Society of Gynaecological Oncology (ESGO) consensus recommendations support this approach (Level of evidence: III, Strength of recommendation: B) 1
• For young patients desiring fertility preservation:
  • Preservation of at least part of one ovary and the uterus is the standard approach 1
  • Cystectomy can be performed with the understanding that there is an increased recurrence risk 1
• Regular follow-up is essential after cystectomy:
  • Transvaginal ultrasound is currently the most effective diagnostic tool for follow-up 5
  • Long-term surveillance is recommended (at least 10 years) 3
• After completing family planning or reaching age 35, some experts recommend considering more definitive surgery due to risk of progression or recurrence 5

Prognosis

• Despite the risk of recurrence, the overall prognosis for patients with benign serous cystadenomas is excellent 2
• In one study, all patients with stage I serous borderline tumors who experienced recurrence were alive without evidence of disease after 3-18 years of follow-up (average 7.5 years) 2