LESSONS FROM A LARGE NATIONWIDE STUDY OF 350 CHILDREN WITH OVARIAN
MATURE TERATOMA: A PLEA FOR OVARIAN-SPARING SURGERY
Abstract
Objective Ovarian mature teratoma (OMT) is a common ovarian tumor found
in the pediatric population. In 10% to 20% of cases, OMT occurs as
multiple synchronous or metachronous lesions on ipsi- or contralateral
ovaries. Ovarian sparing surgery (OSS) is recommended to preserve
fertility, but total oophorectomy (TO) is still performed. This study
reviews the clinical data of patients with OMT, and analyzes risk
factors for second events. Design A retrospective review of all girls
under 18 years of age with OMTs was performed. Data on clinical
features, imaging, laboratory studies, surgical reports, follow-up
second events and their management were retrieved. Results Overall, 350
children were identified. Eighteen patients (5%) presented with a
synchronous bilateral form at diagnosis. Surgery was performed by
laparotomy (85%) and laparoscopy (15%). OSS and TO were performed in
59% and 41% of cases respectively. Perioperative tumor rupture
occurred in 23 cases, independently of the surgical approach.
Twenty-nine second events occurred (8.3%) in a median time of 30.5
months from diagnosis (ipsilateral: 8 cases including one malignant
tumor, contralateral: 18 cases, both ovaries: 3 cases). A large palpable
mass, bilateral forms at diagnosis and perioperative rupture had a
statistical impact on the risk of second event, whereas type of surgery
or approach did not. Conclusion This study is a plea in favor of OSS as
the first choice of treatment of OMT when possible. Close follow-up
during the first five years is mandatory considering the risk of 8.3%
of second events especially in cases with risk factors.