Objective: To evaluate the clinico- pathological features and modalities of treatment that affect recurrence and survival in patients with borderline ovarian tumors. Methods: Data of 92 patients diagnosed with borderline ovarian tumors (BOTs) during the period from 2005 to 2017 in the National Cancer Institute (NCI) and Menoufia University Hospital, Egypt, were retrospectively analyzed. Results: Median follow-up period was 76 months (range, 12-157 months). Histopathology was serous in 63%, mucinous in 28.3%, and endometrioid in 3.3%. Sixty five patients (70.7%) had Stage IA disease, 17 patients had Stage IB disease (18.5%), and 10 patients had advanced disease. Forty nine patients (53.3%) underwent fertility sparing surgery and 43 patients (46.7%) underwent radical surgery. The total recurrence rate was 18.5% (17/92); three patients (17.6%) among those who underwent radical surgery and fourteen patients (82.4%) among those who received fertility sparing surgery. Twelve of the recurrences (70.6%) were borderline while 5 were invasive (29.4%). Multivariate analysis showed that fertility-sparing surgery was the only independent risk factor for worse disease free survival. Risk factors for recurrence in the fertility sparing surgery group were stage, microinvasion and elevated preoperative serum CA125. Conclusion: When considering conservative surgery in patients with borderline ovarian tumors, special care should be given to patients with elevated CA-125, advanced FIGO stage, and microinvasion.