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Pio L, Abu-Zaid A, Zaghloul T, Halepota HF, Davidoff AM, Losty PD, Abdelhafeez HH. Ovarian-sparing surgery for ovarian tumors in children: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106923. [PMID: 37211469 DOI: 10.1016/j.ejso.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/28/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION An increased number of children and adolescents with ovarian tumors have been managed with ovarian-sparing surgery in the last few years. However, comprehensive data on fertility outcomes and local relapse are scarce. In this study, we systematically describe the contemporary outcomes of ovarian-sparing surgery, as reported in the literature. MATERIALS AND METHODS Using PRISMA guidelines, we analyzed studies reporting ovarian-sparing techniques for ovarian tumors in children and adolescents. from 1980 to 2022. Reports with fewer than three patients, narrative reviews, and opinion articles were excluded. Statistical analysis was performed for dichotomous and continuous variables. RESULTS Of 283 articles screened, 16 papers (3057 patients) met inclusion criteria (15 retrospective/1 prospective) and were analyzed. The vast majority of studies had no long-term fertility follow-up data and direct comparison between ovarian-sparing surgery vs oophorectomy was reported in only a few studies. Ovarian sparing surgery was not associated with worse oncologic outcomes in terms of (i) tumour spillage or (ii) recurrence rates, and of key importance allowed a higher ovarian reserve at long term follow-up. CONCLUSIONS Ovarian-sparing surgery is a safe and feasible technique for benign tumors. Long-term outcome studies are needed to show efficacy and fertility preservation.
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Affiliation(s)
- Luca Pio
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
| | - Ahmed Abu-Zaid
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Tarek Zaghloul
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Huma F Halepota
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Andrew M Davidoff
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA
| | - Paul D Losty
- University of Liverpool, Institute of Life Course and Medical Sciences, Liverpool, L69 3BX, UK; Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Hafeez H Abdelhafeez
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA
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2
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Toker Kurtmen B, Dokumcu Z, Divarci E, Ergun O, Ozok G, Celik A. Long-term surgical outcomes in pediatric ovarian neoplasms: 20-year single-center experience. Pediatr Surg Int 2022; 38:2035-2044. [PMID: 36169670 DOI: 10.1007/s00383-022-05256-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The management of pediatric ovarian neoplasms (ON) is based on finding a balance between adequate surgical treatment and future reproductive capacity. We aimed to evaluate long-term results of patients who underwent surgery for ON. METHODS A retrospective cohort study design was used. Medical records of patients with ON were reviewed. They were invited to participate in a telephone-based survey assessing complaints, menstrual status, and post-surgical recurrence. RESULTS Eighty-five patients were operated for ON between 1995 and 2015. Median age at surgery was 14.7 years. 62.4% of patients had ovary-sparing surgery (OSS). Median tumor size in oophorectomy group was significantly larger than OSS group (p = 0.029). Median length of follow-up was 5.1 years. Recurrent/metachronous disease was not significantly different between OSS and oophorectomy groups (p = 1.000). In OSS group, irregular menses (p = 0.004) and painful menses (p = 0.002) were significantly higher than oophorectomy group. CONCLUSION The main goal of treatment in pediatric ON is to find the right balance between adequate and appropriate tumor resection and maximal effort for fertility preservation. Our results showed no difference between oophorectomy and OSS in the terms of recurrence. Although irregular and painful menses were found to be significantly higher in the OSS group, longer follow-up and prospective studies are needed to clarify this issue.
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Affiliation(s)
- Bade Toker Kurtmen
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Zafer Dokumcu
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Emre Divarci
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Orkan Ergun
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Geylani Ozok
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Ahmet Celik
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey.
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Braungart S, Williams C, Craigie RJ, Cross KM, Dick A, Okoye B, Rogers T, Losty PD, Glaser A, Powis M. Reply to "Comment on: Standardizing the surgical management of benign ovarian tumours in children and adolescents: A best practice Delphi consensus statement". Pediatr Blood Cancer 2022; 69:e29737. [PMID: 35484957 DOI: 10.1002/pbc.29737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/10/2022]
Affiliation(s)
- S Braungart
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.,Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - C Williams
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.,Department of Gynaecology, Liverpool Women's Hospital, Liverpool, UK
| | - R J Craigie
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - K M Cross
- Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Dick
- Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - B Okoye
- Department of Paediatric Surgery, St George's Hospital London, UK
| | - T Rogers
- Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - P D Losty
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.,Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - A Glaser
- Department of Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - M Powis
- Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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4
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Gkrozou F, Tsonis O, Vatopoulou A, Galaziou G, Paschopoulos M. Ovarian Teratomas in Children and Adolescents: Our Own Experience and Review of Literature. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101571. [PMID: 36291507 PMCID: PMC9599961 DOI: 10.3390/children9101571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022]
Abstract
Background: Ovarian teratomas are the most common type of ovarian mass during childhood and adolescence. There is no clear guidance for the management of the ovarian teratomas in children and adolescents. It is necessary, however, to understand the feature of these tumours and the indications for operating on them, and to put subjective criteria for the management in elective or emergency presentations. Methods: Medical records of patients between the age of 12 and 20 years old that underwent surgery for ovarian teratomas at the Department of Obstetrics and Gynaecology in University Hospital of Ioannina, between January 2000 and August 2022, were reviewed. A medical database was searched between January 2000 and August 2022 with the following keywords: ovarian teratoma, paediatrics and adolescents. Results: We present the results of forty patients, with a mean age of 11.8 years of age. All patients had surgery, where three out of four underwent oophorectomy and only one out of four underwent ovary-sparing operation; similar results were found in the literature. Conclusion: Ovary-sparing treatment is more common recently compared with the past, such as MIS compared with laparotomy. Better-organised and -planned prospective multi-centre studies are necessary to gain a deeper knowledge of the physiology and prognostic factors of teratomas in children.
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Affiliation(s)
- Fani Gkrozou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Orestis Tsonis
- Assisted Conception Unit, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Anastasia Vatopoulou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Georgia Galaziou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
- Correspondence: ; Tel.: +30-6985726869
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Stefanopol IA, Baroiu L, Chirila S, Miulescu M, Anghel L, Nechita L, Dinu CA, Stefanescu V, Bobeica C, Nechifor A, Tatu AL. The Influence of Living in Rural Areas on the Evolution and Management of Pediatric Ovarian Cystic Lesions: A Retrospective Study on a Cohort from South Eastern Romania. Int J Gen Med 2022; 15:5273-5284. [PMID: 35655655 PMCID: PMC9153997 DOI: 10.2147/ijgm.s368202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ioana Anca Stefanopol
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Department of Pediatric Surgery and Orthopedy, “Sf Ioan” Clinical Emergency Hospital for Children, Galati, Romania
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Infectious Diseases Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galati, Romania
- Correspondence: Liliana Baroiu, Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 47 Domnească Street, Galati, 800010, Romania, Tel +40723201241, Email
| | - Sergiu Chirila
- Medical Informatics and Biostatistics, Faculty of Medicine, Ovidius University, Constanta, Romania
- Sergiu Chirila, Medical Informatics and Biostatistics, Faculty of Medicine, Ovidius University, 1 University Alee, Campus B, Constanta, 900470, Romania, Tel +407213320668, Email
| | - Magdalena Miulescu
- Research Center in the Functional Cardiorespiratory and Neuromotor Exploration, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania
| | - Lucreţia Anghel
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Internal Medicine Department, “sf Andrew the Apostle” County Emergency Clinical Hospital, Galati, Romania
| | - Luiza Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Ciprian Adrian Dinu
- Dental Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Victorita Stefanescu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Alexandru Nechifor
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Alin Laurenţiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Research Center in the Field of Medical and Pharmaceutical Sciences, Reform-UDJ, Galati, Romania
- Dermatology Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galati, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC DIR, Galati, Romania
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6
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Braungart S, Williams C, Arul SG, Bambang K, Craigie RJ, Cross KM, Dick A, Hammond P, Okoye B, Rogers T, Losty PD, Glaser A, Powis M. Standardizing the surgical management of benign ovarian tumors in children and adolescents: A best practice Delphi consensus statement. Pediatr Blood Cancer 2022; 69:e29589. [PMID: 35118808 DOI: 10.1002/pbc.29589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 12/19/2022]
Abstract
AIM No widely agreed consensus protocols exist for the management of benign ovarian tumors (BOT) in children. This presents a substantial risk for suboptimal management. We aimed to generate multispecialty consensus guidance to standardize surgical management and provide a clear follow-up protocol for children with BOTs. METHODS Prospective two-round confidential e-Delphi consensus survey distributed among multispecialty expert panel; concluded by two semistructured videoconferences. MAIN RESULTS Consensus was generated on these core outcome sets: preoperative/intraoperative management; follow-up; adolescent gynecology referral. (1) Children with BOTs should receive the same management as other patients with potentially neoplastic lesions: Preoperative discussion at a pediatric oncology multidisciplinary meeting to risk stratify tumors, and management by health professionals with expertise in ovarian-sparing surgery and laparoscopy. (2) Ovarian-sparing surgery for BOTs should be performed wherever possible to maximize fertility preservation. (3) Ovarian masses detected during emergency laparoscopy/laparotomy should be left in situ wherever feasible and investigated appropriately (imaging/tumor markers) before resection. (4) Follow-up should be undertaken for all patients after BOT resection. Patients should be offered referral to adolescent gynecology to discuss fertility implications. CONCLUSION This best practice Delphi consensus statement emphasizes the importance of managing children with BOTs through a well-defined oncological MDT strategy, in order to optimize risk stratification and allow fertility preservation by ovarian-sparing surgery wherever possible.
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Affiliation(s)
- Sarah Braungart
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.,Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Cara Williams
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.,Department of Gynaecology, Liverpool Women's Hospital, Liverpool, UK
| | - Suren G Arul
- Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Katerina Bambang
- Department of Reproductive Medicine, Liverpool Women's Hospital, Liverpool, UK
| | - Ross James Craigie
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Kate Mary Cross
- Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Alistair Dick
- Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Philip Hammond
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, UK
| | - Bruce Okoye
- Department of Paediatric Surgery, St George's Hospital London, London, UK
| | - Timothy Rogers
- Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Paul Damian Losty
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.,Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Adam Glaser
- Department of Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Mark Powis
- Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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7
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What Should Be the Topics of a Prospective Study on Ovarian Masses in Children?—Results of a Multicenter Retrospective Study and a Scoping Literature Review. Curr Oncol 2022; 29:1488-1500. [PMID: 35323325 PMCID: PMC8946882 DOI: 10.3390/curroncol29030125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/19/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: to determine management problems of ovarian masses in girls in order to form a baseline for prospective randomized studies of the established topics and quality improvement of our management. Materials and Methods: We performed a national analysis of clinical aspects of ovarian masses in girls operated on in Poland, analyzed retrospectively medical files of all consecutive patients aged 0–18 who underwent surgeries for ovarian lesions between 2012 and 2017 at 17 pediatric surgical departments and complemented the analysis with a scoping review of a recent primary research related to ovarian masses in children. Results: The study group comprised 595 patients. Forty-four (7.39%) girls were diagnosed with malignant tumors. The overall preservation rate was 64.54%. The analysis revealed that positive tumor markers (OR = 10.3), lesions larger than 6 cm (OR = 4.17) and solid mass on ultrasound examination (OR = 5.34) are interdependent variables differentiating malignant tumors from non-malignant lesions (X42 = 79.1; p = 0.00000). Our scoping review revealed 10 major branches of research within the topic of ovarian masses in pediatric population. Conclusions: We have developed an overview of the field with the emphasis on the local environment. Our next step is a multi-institutional prospective study of a quality improvement project implementation based on the obtained knowledge.
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8
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Braungart S, Smith CV. Recurrence and Metachronous Disease in Children with Benign Ovarian Tumors: A Systematic Review of the Literature. Eur J Pediatr Surg 2022; 32:98-104. [PMID: 35016253 DOI: 10.1055/s-0041-1740997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM The majority of ovarian tumors in children are benign, with good prognosis following complete resection. Little is published on the incidence of tumor recurrence and metachronous disease, and follow-up management of children with benign ovarian tumors (BOTs) remains a matter of debate. This systematic review aimed to evaluate the incidence and timing of recurrence and metachronous disease in children with BOTs in pediatric literature. METHODS Comprehensive literature searches of the English literature (PubMed, OVID, EMBASE databases) from inception to present according to the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Outcomes for tumor recurrence and metachronous disease were synthesized. RESULTS Nineteen studies comprising 1,069 patients with BOTs were included in the analysis. All studies were retrospective cohort studies of children less than 18 years old. A total of 56 events of recurrence or metachronous disease were reported in these patients. The overall risk of recurrence/metachronous event occurrence was 5.2%/2.9%. Seventy-five percent of events occurred within the first 4 years following resection. CONCLUSION Although the studies identified are few and heterogeneous, they demonstrate a significant risk of tumor recurrence and metachronous disease for children following resection of a BOT.Especially following total unilateral oophorectomy, these children are at risk of losing the contralateral ovary in case of metachronous disease.Immediate discharge from follow-up, therefore, does not appear safe. The majority of events occurred within the first 4 years following resection. Follow-up for children following resection of a BOT should, therefore, be continued for a minimum of 4 years following surgery. Larger, long-term prospective studies are required to more accurately determine the true incidence and long-term outcomes for children and adolescents with these tumors.
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Affiliation(s)
- Sarah Braungart
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Charlotte Victoria Smith
- North West of England School of Foundation Training and Physician Associates - FY2, St Helen's and Knowsley, United Kingdom of Great Britain and Northern Ireland
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9
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Knaus ME, Lawrence AE, Onwuka AJ, Abouelseoud NM, Breech LL, Brito KS, Dekonenko C, Hertweck SP, Hong HY, Menon S, Merritt DF, Schikler AG, Senapati N, Smith YR, Strickland JL, Truehart AI, Minneci PC, Hewitt GD. Recommendations for Postoperative Surveillance of Pediatric Benign Ovarian Neoplasms. J Pediatr Adolesc Gynecol 2021; 34:666-672. [PMID: 33989806 DOI: 10.1016/j.jpag.2021.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/19/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To assess postoperative management of pediatric patients with benign ovarian neoplasms, to develop recommendations for postoperative care. DESIGN A retrospective cohort study. SETTING Eight pediatric hospitals in the midwestern United States. PARTICIPANTS Patients up to 21 years of age who underwent surgery for a benign ovarian neoplasm between January 2010 and December 2016 were included. INTERVENTIONS No prospective interventions were evaluated. MAIN OUTCOME MEASURES Main outcome measures included postoperative imaging findings, recurrence rates, reoperation rates, and the timing of the aforementioned results. RESULTS A total of 427 patients met inclusion criteria. After the index surgery, 155 patients (36%) underwent a routine imaging study. Among those with routine imaging, abnormalities were noted in 48 patients (31%); 7 went on to have reoperation (5%), and no malignant pathologies or torsion were identified. Excluding the 7 patients who went on to have a reoperation as a result of routine imaging, 113 patients developed symptoms postoperatively and underwent imaging as a result (27%, 113/420). Abnormalities were noted in 44 (10%); 15 of these patients underwent reoperation (4%), among them 2 with malignancies and 3 with torsion. Of these 44 patients, 23 had initially undergone routine imaging and subsequently went on to have symptomatic imaging, with 17% (4/23) undergoing reoperation. CONCLUSIONS Routine imaging did not identify malignancy; most lesions identified on routine imaging were incidental findings. Although the study was not powered to appreciate a statistically significant difference, patients with malignancy or torsion were identified in the symptomatic group. This suggests no benefit from routine imaging, and supports symptomatic imaging postoperatively to minimize costs and patient/family burden.
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Affiliation(s)
- Maria E Knaus
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Amy E Lawrence
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Amanda J Onwuka
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Naila M Abouelseoud
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lesley L Breech
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Katherine S Brito
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Charlene Dekonenko
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - S Paige Hertweck
- Division of Pediatric and Adolescent Gynecology, Norton Children's Gynecology, Louisville, Kentucky
| | - Helena Y Hong
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, California
| | - Seema Menon
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, Wisconsin
| | - Diane F Merritt
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis Children's Hospital, St. Louis, Missouri
| | | | - Nikki Senapati
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Yolanda R Smith
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Julie L Strickland
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Children's Mercy Hospital, Kansas City, MO
| | - Amber I Truehart
- Section of Family Planning, Department of Obstetrics and Gynecology, University of Chicago Medicine, Chicago, Illinois
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Geri D Hewitt
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio.
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10
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Arthur F, Hennessey I, Pizer B, Losty PD. Surgical management and outcomes of paediatric ovarian tumours-a 25-year UK single centre experience. Pediatr Surg Int 2021; 37:1355-1359. [PMID: 34170394 DOI: 10.1007/s00383-021-04950-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ovarian neoplasms in children are rare heterogeneous lesions with variable biological behaviour and outcome. We herein report a 25-year experience from a UK specialist centre managing paediatric ovarian tumours. METHODS All female patients requiring operation for ovarian tumours were identified during the study period 1990-2018. Patient demographics, clinical presentation, and management are highlighted. RESULTS Eighty-eight females with 101 ovarian tumours including cases with synchronous and metachronous neoplasms were documented. Mean age at diagnosis was 11.8 years. Tumours were equally distributed in left and right ovary(s). Bilateral disease occurred in 11 (10.8%) patients. Eighty-six (85%) neoplasms were benign and 15 (15%) malignant requiring in addition to surgery chemotherapy and/or radiation. There were no significant difference(s) observed in maximum tumour diameter in benign vs malignant lesions. Only half of malignant tumours had positive tumour markers. Fifteen patients (15%) had ovarian lesions that were metastatic at primary presentation including a rare case of disseminated peritoneal gliomatosis. Surgical management included salpingo-oopherectomy n = 21 (21%), ovary excision n = 33 (33%), 'ovary sparing' tumourectomy n = 34 (34%), and cyto-reductive extirpation in 2 cases (2%). Lymphadenectomy was performed in 9 patients (9%) together with peritoneal fluid cytology in 18 cases (18%) who had abdominal ascites. Omentectomy was required in 14 patients (14%), multiple peritoneal biopsy(s)-in 11 cases (11%) and biopsy of other suspicious involved organs notably bowel, gut mesentery and contralateral ovary in 7 (7%) further patients. Recurrent and metachronous lesions occurred in 10 (10%) cases in those with teratoma (n = 9) and adenocarcinoma(s) (n = 1). Overall patient survival was 97% with only 3 deaths-mucinous cystadenocarcinoma (n = 1), desmoplastic small round cell tumour of ovarian origin (n = 1), and a small cell carcinoma of ovary with hypercalcaemia (n = 1). CONCLUSIONS Findings from this study show an excellent survival (97%) for paediatric ovarian neoplasms. Rare malignant neoplasms though do carry a poor prognosis. In the modern era of care, all efforts should be made to preserve future hormonal health and fertility with 'ovarian sparing' operation(s) where appropriate.
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Affiliation(s)
- Felicity Arthur
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Iain Hennessey
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Barry Pizer
- Department of Paediatric Oncology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.,School of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Paul D Losty
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK. .,School of Health and Life Sciences, University of Liverpool, Liverpool, UK.
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Braungart S, Craigie RJ, Farrelly P, Losty PD. Operative management of pediatric ovarian tumors and the challenge of fertility-preservation: Results from the UK CCLG Surgeons Cancer Group Nationwide Study. J Pediatr Surg 2020; 55:2425-2429. [PMID: 32234316 DOI: 10.1016/j.jpedsurg.2020.02.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ovarian tumors in the pediatric age group are rare. A significant number of children with ovarian mass lesions present "out of hours "as surgical emergencies, and surgical management does not always involve a surgical oncologist. This multicenter study reports how the mode of clinical presentation may influence (i) operation (conventional open vs minimally invasive surgery (MIS)) and (ii) examines if young females presenting as surgical emergency(s) are more likely to undergo total oophorectomy or ovarian sparing surgery. METHODS Retrospective multicenter study amongst UK pediatric surgical oncology centers. Females <16 years with diagnosis of ovarian tumor from 2006 to 2016 were included. Functional/neonatal ovarian cysts were excluded. RESULTS Three hundred ten patients with ovarian tumors treated at 12 surgical oncology centers were identified. Mean age at surgery was 11 years [IQR 8-14]. Most common diagnosis were mature teratoma (57%, 177 cases), immature teratoma (10.9%, 34 cases) and cystadenoma (12%, 36 cases). Seventy percent (217) of cases were performed as open procedures. Thirty percent (94) of children underwent MIS. Tumors were significantly smaller in children who underwent MIS. Median tumor size in the laparoscopic group was 6 cm compared to 11 cm in the open group (p < 0.00001). Children who underwent MIS were significantly more likely to have ovary sparing surgery. CONCLUSION This UK nationwide study demonstrates that ovary-sparing surgery and minimally invasive surgery are still infrequently deployed by pediatric surgeons in the UK. Patients with smaller tumors were more likely to undergo MIS, and more frequently underwent ovary-sparing surgery. In view of the implications on fertility and hormonal health caused by unilateral oophorectomy, it is time to review this current practise and agree consensus guidelines to reduce rates of unnecessary oophorectomy. LEVEL OF EVIDENCE STATEMENT This is a level II evidence study. It is a retrospective multicentre collaborative study, which summarizes data from a national cohort of children.
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Affiliation(s)
- Sarah Braungart
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK; Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.
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- CCLG Surgeons Cancer Group, Children's Cancer and Leukaemia Group, Leicester, UK
| | - Ross J Craigie
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Paul Farrelly
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Paul D Losty
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK; University of Liverpool, Liverpool L69 3BX, UK
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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. [PMID: 31837839 DOI: 10.1016/j.jpedsurg.2019.10.059] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Ovarian tumors in children are rare, mature teratoma being the most common histological entity. Robust guidelines to aid patient follow-up after resection are distinctly lacking. Although mature teratoma has a very good prognosis following complete resection, small studies have reported the occurrence of metachronous disease and recurrence to a variable degree (2.5-23% of patients). Nevertheless, there are surgeons who recommend no follow-up is required for these children after primary tumor resection. We investigated the incidence of (i) recurrence and (ii) metachronous disease in pediatric patients following ovarian tumor resection. METHODS Retrospective multicenter study amongst UK pediatric surgical oncology centers. Females <16 years with diagnosis of ovarian tumor from 2006 to 2016 were included. Functional/neonatal ovarian cysts were excluded. RESULTS Three hundred ten patients with ovarian tumors treated at 12 surgical oncology centers were identified. Mean age at surgery was 11 years [IQR 8-14]. Most common diagnosis were mature teratoma (57%, 177 cases), immature teratoma (10.9%, 34 cases) and serous cystadenoma (7.7%, 24 cases). 8.1% (25 cases) of all females were identified with tumor recurrence/ metachronous disease. 5.1% (9 cases) of patients with mature teratoma had recurrent/ metachronous disease. Most of these patients were diagnosed at routine clinic follow-up. CONCLUSION Our study clearly shows that ovarian tumor recurrence(s) and metachronous disease occur, even in "benign" ovarian tumors. We recommend female pediatric patients should have robust follow-up care plans after primary diagnosis and resection of ovarian tumor(s). LEVEL OF EVIDENCE STATEMENT This is a level II evidence study. It is a retrospective multicentre collaborative study which summarizes data from a national cohort of children.
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Affiliation(s)
- S Braungart
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK; Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.
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- CCLG Surgeons Cancer Group, Children's Cancer and Leukaemia Group, Leicester, UK
| | - R J Craigie
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.
| | - P Farrelly
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.
| | - P D Losty
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK; University of Liverpool, Liverpool, L69 3BX, UK.
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Vázquez Rueda F, Murcia Pascual FJ, Siu Uribe A, Ortega Salas RM, Escassi Gil Á, Garrido Pérez JI, Paredes Esteban RM. Analysis of solid ovarian tumours in a Spanish paediatric population. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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14
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Elgendy A, Lakshminarayanan B, Elrouby A, Mostafa M, Salem MA, Turner K, Khairi A, Squire R, K Shehata SM, Shehata S, Powis M. Management of pediatric benign ovarian tumors in England and Egypt: A comparative study. Afr J Paediatr Surg 2020; 17:33-38. [PMID: 33106451 PMCID: PMC7818669 DOI: 10.4103/ajps.ajps_64_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIM OF THE STUDY We aimed to compare the management of pediatric benign ovarian tumors between an English center and three Egyptian institutions. MATERIALS AND METHODS This was a retrospective review of all children presenting with benign ovarian tumors between January 2014 and January 2019. A standardized dataset was used to compare between both sides. RESULTS Eighty-nine patients were included (54 English and 35 Egyptians). Median age at diagnosis in England was 13 years (2-16y), while in Egypt it was 7 years (9m-16y) with P =0.001. Mature teratomas or dermoid cysts were the most common findings in England and Egypt; 75.9% and 82.8% of cases, respectively. The presentation with an acute abdomen represented 27.8% of English and 28.6% of Egyptian patients. Incidentally diagnosed lesions constituted 15% of English patients, whereas none of the Egyptian cases were discovered incidentally. There were variations in diagnostic imaging; England: Ultrasound (USS) (54), magnetic resonance imaging (MRI) (37), and computed tomography (CT) (only one)-Egypt: USS (35), CT (17), and MRI (only one). Minimally invasive surgery (MIS) was performed in 15% of English and 23% of Egyptian patients (P = 0.334). Ovarian-sparing surgery (OSS) was performed in: England 35%, Egypt 37%; P = 0.851. OSS was performed using MIS in 87.5% (7/8) of English patients and 100% (8/8) of Egyptians. Patients presented as emergencies generally had open oophorectomies: England; 86.7% open and 80% oophorectomy-Egypt; 100% open and 90% oophorectomy. Recurrences or metachronous disease occurred in 5.6% of English and 5.7% of Egyptian patients. CONCLUSIONS There were no significant differences regarding surgical management, tumor pathology, and recurrence or metachronous disease. However, age, incidental diagnosis, and imaging modalities showed notable differences. MIS was correlated with ovarian preservation, whereas emergency surgery generally resulted in open oophorectomy.
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Affiliation(s)
- Ahmed Elgendy
- Surgical Oncology Unit, Department of Surgery, Tanta University, Tanta, Egypt
| | | | - Ahmed Elrouby
- Department of Pediatric Surgery, Alexandria University, Alexandria, Egypt
| | - Mahmoud Mostafa
- Department of Pediatric Surgery, Assiut University, Assiut, Egypt
| | | | - Kerry Turner
- Department of Pathology, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK
| | - Ahmed Khairi
- Department of Pediatric Surgery, Alexandria University, Alexandria, Egypt
| | - Roly Squire
- Department of Pediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK
| | | | - Sameh Shehata
- Department of Pediatric Surgery, Alexandria University, Alexandria, Egypt
| | - Mark Powis
- Department of Pediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK
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Management of Ovarian Tumors and Adnexal Torsion in Children; How to Save? JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.577708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vázquez Rueda F, Murcia Pascual FJ, Siu Uribe A, Ortega Salas RM, Escassi Gil Á, Garrido Pérez JI, Paredes Esteban RM. [Analysis of solid ovarian tumours in a Spanish paediatric population]. An Pediatr (Barc) 2019; 92:88-93. [PMID: 30975583 DOI: 10.1016/j.anpedi.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Ovarian tumours are rare in childhood, and account for 1-5% of all tumours. The aim of this study is to determine the epidemiological features, histological subtypes, and therapeutic management of ovarian solid ovarian tumours of the paediatric population of the province of Cordoba, in Spain. MATERIAL AND METHODS A retrospective, descriptive, observational and institutional study was conducted in which a review was made of the clinical histories of patients younger than 14years-old diagnosed with ovarian tumours, excluding secondary tumours in a University Hospital between 1994 and 2017. A review was carried out on the age, clinical presentation, laterality, diagnostic methodology, treatment, histopathology, and evolution of these tumours. RESULTS A total of 37 ovarian tumours were reviewed in 31 patients, 6 of them being bilateral. The mean age was 10.3 (0-14) years, with 58% presenting as a palpable mass. There was no predominance of laterality. The tumour markers were negative. Conservative surgery was performed in 29.7% and adnexectomy in 70.3%. Only one case required post-operative adjuvant chemotherapy treatment (stageI immature teratoma with peritoneal gliomatosis). The histological study shows a predominance of germ cell tumours (65%) against those of epithelial lineage (22%). There were 3 stromal tumours that corresponded to fibroma (Gorlin syndrome), and bilateral gonadoblastoma associated with Frasier syndrome. The most frequent type of tumour was mature cystic teratoma (35.1%). There were no complications in the follow-up. CONCLUSIONS Given that most childhood ovarian tumours are benign, conservative surgery is considered as the first choice, being even more important in bilateral tumours. If there is a family history, it is essential to carry out molecular genetic studies, to rule out associated syndromes.
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Affiliation(s)
- Fernando Vázquez Rueda
- UGC Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España; Facultad de Medicina, Universidad de Córdoba; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España.
| | | | - Ariadna Siu Uribe
- UGC Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España
| | | | - Álvaro Escassi Gil
- UGC Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España
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