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Failure of Operative Therapy after Ovarian-Sparing Surgery for Pediatric Benign Ovarian Neoplasms: A Retrospective Review

Published:August 28, 2022DOI:https://doi.org/10.1016/j.jpag.2022.08.010

      ABSTRACT

      Study Objective

      To evaluate failure of initial operative therapy (incomplete tumor removal) of ovarian-sparing surgery for pediatric benign ovarian neoplasms.

      Methods

      A retrospective review of patients up to 21 years of age who underwent ovarian-sparing surgery for a benign ovarian neoplasm from 2010 to 2016 at 8 pediatric hospitals was conducted. Failure of initial operative therapy is defined as a radiologically suspected or pathologically confirmed ipsilateral lesion with the same pathology as the primary neoplasm within 12 weeks of the initial operation.

      Results

      Forty patients received imaging within 12 weeks of their primary operation. Sixteen (40%) patients had a radiologically identified ovarian abnormality ipsilateral to the primary lesion, and 5 patients were suspected to have the same lesion as their primary neoplasm. Three of the 5 patients (7.5%) underwent reoperation with pathologic confirmation of the same lesion, resulting in a pathologically confirmed failure of therapy rate of 7.5%. The other 2 patients had serial imaging that subsequently demonstrated no recurrence with lesion resolution. Age, race/ethnicity, laparoscopy vs laparotomy, presence of torsion, pathology, size of lesion, and surgeon specialty were not associated with failure of therapy.

      Conclusion

      In most patients who received imaging within 12 weeks of the primary operation for resection of a benign ovarian neoplasm, ovarian-sparing surgery was successful in complete tumor removal, with a low failure of therapy rate. Selected patients with suspected failure of therapy on initial imaging could be serially monitored to determine the need for repeat surgical intervention.

      Key Words

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      References

        • Skinner MA
        • Schlatter MG
        • Heifetz SA
        • Grosfeld JL
        Ovarian neoplasms in children.
        Arch Surg. 1993; 128: 849-854
        • Yasui T
        • Hayashi K
        • Mizunuma H
        • et al.
        Factors associated with premature ovarian failure, early menopause and earlier onset of menopause in Japanese women.
        Maturitas. 2012; 72: 249-255
        • Rocca WA
        • Bower JH
        • Maraganore DM
        • et al.
        Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause.
        Neurology. 2007; 69: 1074-1083
        • Lind T
        • Holte J
        • Olofsson JI
        • et al.
        Reduced live-birth rates after IVF/ICSI in women with previous unilateral oophorectomy: results of a multicentre cohort study.
        Hum Reprod. 2018; 33: 238-247
        • Agarwal P
        • Agarwal P
        • Bagdi R
        • et al.
        Ovarian preservation in children for adnexal pathology, current trends in laparoscopic management and our experience.
        J Indian Assoc Pediatr Surg. 2014; 19: 65-69
        • Chabaud-Williamson M
        • Netchine I
        • Fasola S
        • et al.
        Ovarian-sparing surgery for ovarian teratoma in children.
        Pediatr Blood Cancer. 2011; 57: 429-434
        • Abbas PI
        • Dietrich JE
        • Francis JA
        • et al.
        Ovarian-sparing surgery in pediatric benign ovarian tumors.
        J Pediatr Adolesc Gynecol. 2016; 29: 506-510
        • Lawrence AE
        • Minneci PC
        • Deans KJ:
        Ovary-sparing surgery for benign pediatric ovarian masses.
        Curr Opin Pediatr. 2019; 31: 386-390
        • Özcan R
        • Kuruoğlu S
        • Dervişoğlu S
        • et al.
        Ovary-sparing surgery for teratomas in children.
        Pediatr Surg Int. 2013; 29: 233-237
        • Al Jama FE
        • Al Ghamdi AA
        • Gasim T
        • et al.
        Ovarian tumors in children and adolescents—a clinical study of 52 patients in a university hospital.
        J Pediatr Adolesc Gynecol. 2011; 24: 25-28
        • Cass DL
        • Hawkins E
        • Brandt ML
        • et al.
        Surgery for ovarian masses in infants, children, and adolescents: 102 consecutive patients treated in a 15-year period.
        J Pediatr Surg. 2001; 36: 693-699
        • De Backer A
        • Madern GC
        • Oosterhuis JW
        • et al.
        Ovarian germ cell tumors in children: a clinical study of 66 patients.
        Pediatr Blood Cancer. 2006; 46: 459-464
        • Massicot R
        • Rousseau V
        • Darwish AA
        • et al.
        Serous and seromucinous infantile ovarian cystadenomas—a study of 42 cases.
        Eur J Obstet Gynecol Reprod Biol. 2009; 142: 64-67
        • Rogers EM
        • Allen L
        • Kives S:
        The recurrence rate of ovarian dermoid cysts in pediatric and adolescent girls.
        J Pediatr Adolesc Gynecol. 2014; 27: 222-226
        • Taskinen S
        • Urtane A
        • Fagerholm R
        • et al.
        Metachronous benign ovarian tumors are not uncommon in children.
        J Pediatr Surg. 2014; 49: 543-545
        • Knaus ME
        • Lawrence AE
        • Onwuka AJ
        • et al.
        Recommendations for postoperative surveillance of pediatric benign ovarian neoplasms.
        J Pediatr Adolesc Gynecol. 2021; 34: 666-672
        • Rivera CM
        • Grossardt BR
        • Rhodes DJ
        • et al.
        Increased cardiovascular mortality after early bilateral oophorectomy.
        Menopause. 2009; 16: 15-23
        • Amies Oelschlager A-ME
        • Gow KW
        • Morse CB
        • Lara-Torre E
        Management of large ovarian neoplasms in pediatric and adolescent females.
        J Pediatr Adolesc Gynecol. 2016; 29: 88-94
        • Childress KJ
        • Santos XM
        • Perez-Milicua G
        • et al.
        Intraoperative rupture of ovarian dermoid cysts in the pediatric and adolescent population: should this change your surgical management?.
        J Pediatr Adolesc Gynecol. 2017; 30: 636-640
        • Karpelowsky JS
        • Hei ER
        • Matthews K:
        Laparoscopic resection of benign ovarian tumours in children with gonadal preservation.
        Pediatr Surg Int. 2009; 25: 251-254
        • Laberge PY
        • Levesque S:
        Short-term morbidity and long-term recurrence rate of ovarian dermoid cysts treated by laparoscopy versus laparotomy.
        J Obstet Gynaecol Can. 2006; 28: 789-793
        • Knaus ME
        • Onwuka AJ
        • Afrazi A
        • et al.
        Laparoscopy versus laparotomy for pediatric ovarian dermoids.
        J Pediatr Surg. 2022; (Feb 12:S0022-3468(22)00134-8)https://doi.org/10.1016/j.jpedsurg.2022.01.053
        • Braungart S
        • Craigie RJ
        • Farrelly P
        • Losty PD:
        Ovarian tumors in children: how common are lesion recurrence and metachronous disease? A UK CCLG Surgeons Cancer Group nationwide study.
        J Pediatr Surg. 2020; 55: 2026-2029