The role of omentectomy in the surgical management of mucinous and serous borderline ovarian tumors

Background: This systematic review evaluates the role of omentectomy in borderline ovarian tumors (BOTs), particularly mucinous BOTs (mBOTs). Considering the differences in the prevalence of omental disease between serous BOTs (sBOTs) and mBOTs, the necessity of omentectomy in mBOTs is controversial. Methods: A systematic literature search was conducted using two electronic databases—PubMed and Scopus—following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. Studies providing data on omentectomy in BOTs were included in this review. Results: A total of 40 studies involving over 7000 patients were included. Among the 37 studies that reported performing omentectomy, 19 (51.4%) reported the presence of omental disease: with sBOT in 15 studies (78.9%) and with mBOT in 3 studies (15.8%) and the rest did not report the BOT subtype. The highest rate of omental disease in mBOT patients was reported at 5.4% in one study. No cases of upstaging due to omental involvement were observed in mBOT patients. Also, the prevalence of peritoneal implants seem to be higher in sBOTs than in mBOTs. The impact of omentectomy on recurrence and survival varied between studies. The higher recurrence rates are reported among patients undergoing fertility-sparing surgery but no significant difference in survival is seen. Conclusions: Omentectomy may not be necessary for mBOT patients due to the low risk of omental disease. Omentectomy remains essential for sBOT patients due to the higher risk of extra-ovarian disease in the omentum. The PROSPERO Registration: CRD420251139223.