Minimally invasive surgery reduced operative burden in overweight and obese borderline ovarian tumor patients
Minimally invasive surgery MIS was associated with cleaner perioperative recovery than open surgery in overweight or obese patients treated for borderline ovarian tumor BOT. Across a 17-year retrospective cohort from Korea University Anam Hospital, the laparoscopic and robotic approaches were linked to shorter surgical time, less blood loss, shorter hospitalization, and less need for extra analgesics despite patient-controlled analgesia.
The clinical contrast was not subtle. Patients managed with MIS left the operating room and the ward with fewer markers of procedural stress, while disease control remained similar between the two groups during follow-up.
Cohort composition and surgical comparison
Investigators reviewed 128 patients with a body mass index of 25 or higher who underwent surgery for BOT between 2006 and 2023. Ninety patients were treated with MIS, including laparoscopic or robotic surgery, and 38 underwent open surgery. The analysis used standard comparative tests and logistic regression to identify factors associated with additional analgesic use.
In direct perioperative terms, MIS outperformed open surgery on several fronts. Surgical time was shorter, estimated blood loss was lower, and length of stay dropped as well, with each comparison reaching statistical significance. For patients with elevated body weight, those differences matter because larger abdominal wall incisions can magnify postoperative pain, slow ambulation, and increase the physiologic toll of recovery.
Bot tumors sit in a gray zone between benign ovarian disease and invasive malignancy, so surgeons must balance oncologic precision with recovery burden. In that setting, the ability to reduce access trauma without sacrificing disease control is clinically meaningful.
Rescue analgesia needs point to a less painful recovery
The strongest bedside signal came from pain management. Patients in the MIS group had a lower rate of additional analgesic use despite receiving patient-controlled analgesia. In the adjusted model, MIS was associated with a markedly reduced likelihood of requiring extra analgesics, with an adjusted odds ratio of 0.13 and a 95% confidence interval from 0.037 to 0.470.
Pain after ovarian surgery is driven in part by the size and location of the incision, the degree of peritoneal handling, and the inflammatory response that follows tissue disruption. Smaller ports and less traction in MIS plausibly blunt that cascade, which helps explain why rescue medication was needed less often even after baseline analgesic control was already in place.
Open surgery leaves a larger inflammatory footprint.
Oncologic outcomes remained comparable during follow-up
Perioperative advantages would mean little if they came at the expense of cancer control. In this cohort, disease-free survival did not differ significantly between MIS and open surgery, and no deaths occurred during follow-up. The absence of a survival gap supports the idea that a less invasive approach can preserve oncologic outcomes in appropriately selected patients with BOT.
Borderline ovarian tumors are often treated surgically with a focus on complete resection and accurate staging rather than aggressive cytoreduction. When disease-free survival remains stable while morbidity falls, the balance shifts toward the less invasive technique, especially for patients already carrying the mechanical and anesthetic burdens associated with overweight or obesity.
Why body habitus changes the operative equation
Patients with higher body mass index often face longer operative exposure, deeper operative fields, and more difficult wound healing. Larger incisions increase postoperative pain and can delay mobilization, which in turn may prolong hospitalization. MIS reduces the size of the abdominal wall injury and can limit blood loss, two factors that likely contributed to the shorter hospital stay and lower analgesic requirements observed in this series.
Robotic and laparoscopic techniques also allow more precise dissection in confined pelvic anatomy. In ovarian surgery, that precision may be especially useful when surgeons need to remove a tumor intact while minimizing disruption to surrounding tissue. The result is a recovery profile that is easier on the patient without an obvious penalty in short-term cancer outcomes.
Practical limits of a retrospective cohort
The evidence is encouraging, but the design leaves important questions open. This was a retrospective study from a single institution, and treatment selection was not randomized. Surgeons may have chosen MIS for patients whose anatomy, tumor characteristics, or overall condition made a minimally invasive approach more feasible, which can influence outcomes independent of the technique itself.
The study also spans a long time window, from 2006 to 2023, during which surgical equipment, perioperative care, and clinician experience likely changed. Those shifts can affect operative time, blood loss, and pain control. Even so, the consistency of the results across several perioperative endpoints strengthens the argument that MIS was associated with a real recovery advantage in this group.
What this means for borderline ovarian tumor surgery
For overweight or obese patients with BOT, the central takeaway is straightforward: MIS was linked to less surgical trauma and less need for additional pain treatment during hospitalization, while disease-free survival remained similar to that seen with open surgery. The findings support MIS as a feasible option when oncologic goals and anatomy permit a minimally invasive route.
Surgeons managing BOT in patients with elevated body mass index may use these data to justify a lower-access strategy when technical conditions are favorable. The remaining uncertainty lies in how broadly the results apply across other institutions, tumor subtypes, and staging scenarios, and whether similar advantages persist in prospective comparisons with standardized perioperative pathways.