Introduction: Borderline ovarian tumors (BOTs) account for 15–20% of all epithelial ovarian neoplasms, are most frequently diagnosed in women of reproductive age, and are represented by serous and mucinous histotypes in 96% of cases. The main morphological difference between BOTs and adenocarcinoma is the absence of destructive stromal invasion. This feature allows for minimally invasive conservative (adnexectomy) and ultra-conservative (cystectomy, resection) surgeries aimed at preserving patients fertility and hormonal status.

Research Objective: To improve surgical outcomes for BOT and to determine the optimal timing for reproductive function realization during «the recurrence-free window» after conservative and ultra-conservative minimally invasive procedures.

Methods: The study included 45 women of reproductive age according to WHO criteria, with a verified diagnosis of serous and mucinous borderline ovarian tumors, from 2019 to 2025. Of these, 33 patients (73.3%) underwent conservative treatment. 12 patients (26.7%) received ultra-conservative treatment. All patients underwent minimally invasive laparoscopic access. Treatment results were evaluated using instrumental diagnostic methods: pelvic ultrasound and pelvic MRI. Laboratory methods used for dynamic monitoring included CA125, HE4, ROMA index /CA 19-9 and REA.

Results: In 30 patients (66.7%), no recurrences have been detected to date; among them, 24 patients (80%) underwent conservative minimally invasive treatment, and 6 patients (20%) received ultra-conservative treatment. Recurrence was observed in 15 patients (33.3%). After conservative treatment, 9 patients (60%) experienced recurrence between 1 and 6 years postoperatively. After ultra-conservative treatment, 6 patients (40%) experienced recurrence between 1 and 3 years postoperatively.

Conclusions: The conducted study demonstrates high efficacy of conservative and ultra-conservative minimally invasive methods in treating BOT in women of reproductive age, aimed at preserving fertility and maintaining hormonal status. Ultra-conservative approaches allow for the preservation of reproductive function but require strict dynamic monitoring due to the risk of recurrence, especially in the early postoperative period. The optimal timing for reproductive function realization can be determined immediately after surgery.

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