Ovarian Sparing Surgery in Mature Ovarian Teratomas in Children: A 20-Year Single-Center Experience

Abstract

Introduction Despite its benign nature, possible bilateral presentation, and a very good prognosis, ovarian sparing tumorectomy (OST) in mature ovarian teratoma (MOT) is not commonly performed. Unilateral oophorectomy has physiological consequences, while bilateral is devastating. The aim of this study is promotion of OST in MOT among children. Materials and Methods We reviewed 120 patients operated for MOT between August 1999 and 2019. Results Ovariectomy was performed in 15 patients (14 between 1999 and 2009 and 1 after 2010). In 105 girls, OST was possible including 32 with ovarian torsion. The approach was laparoscopy in 30 girls (11 conversions) and laparotomy in 94. Intra-abdominal spillage occurred in 30% of laparoscopic dissections. Postoperative morbidity was not associated with surgical approach (p = 0.613) or presence of adnexal torsion (p = 0,608). Follow-up was from 4 months to 9 years (median = 4 years) with access to 90% of patients. Bilateral lesions were observed in six (synchronous in five and metachronous in one) patients. Recurrence appeared in three patients operated via laparotomy and OST (after 12, 46, and 74 months). In one girl, asynchronous contralateral MOT was found 5 years after unilateral oophorectomy. Ovarian regeneration after torsion was observed in sonography in 84.4% of the patients. None of the patients experienced chemical peritonitis or malignant tumor transformation. Conclusion OST is safe and effective and should be the first-line procedure in children. Laparoscopy and laparotomy constitute a complementary approach to MOT. Ultrasound follow-up is necessary to monitor recurrence, contralateral disease, and ovarian regeneration.

Lessons from a large nationwide cohort of 350 children with ovarian mature teratoma: A study in favor of ovarian‐sparing surgery

“…In accordance with other studies, our experience showed that laparoscopy and laparotomy can both be safely practiced for OMT surgery without any influence on its recurrence 19,25 . Laparoscopy has the advantages of decreasing postoperative pain, complications, and length of hospitalization 6–8,21,26–28 . It also minimizes postoperative adhesions, which may have an impact on fertility 6,7,25,28 .…”

“…Bilateral forms and OMT second events were reported in 5% and 8.3% of cases in our cohort, which may lead to additional amputation of the ovarian tissue. All these features plead to conservative surgery to preserve the ovarian tissue as much as possible 8,11,14,27,28,33 . In our series, all patients maintained at least one ovary even after recurrence.…”

“…As the EFS curve did not show any plateau, it suggests the need for prolonged surveillance after surgery 18,28 . Despite the lack of guidelines regarding the FU after OMT resection in children, and considering the median time to a second event of 30.5 months, we suggest a pelvic and abdominal US exam every 6 months during the 5 years following initial surgery.…”

“…Laparoscopy has the advantages of decreasing postoperative pain, complications, and length of hospitalization 6–8,21,26–28 . It also minimizes postoperative adhesions, which may have an impact on fertility 6,7,25,28 . All of these benefits promote laparoscopy as the first surgical approach in adults 6,21,22 .…”

“…All of these benefits promote laparoscopy as the first surgical approach in adults 6,21,22 . However, more tumor rupture and spillage are described during laparoscopy, and this risk increases when OSS is considered 6,28,29 …”