P. I. Abbas1, J. E. Dietrich2, J. C. Francis2, M. L. Brandt1, D. L. Cass1, M. E. Lopez1 1Baylor College Of Medicine,Michael E. DeBakey Department Of Surgery,Houston, TX, USA 2Baylor College Of Medicine,Department Of Obstetrics And Gynecology,Houston, TX, USA
Introduction: Ovarian sparing surgery (OSS) is the recommended treatment for benign pediatric ovarian masses in order to optimize future fertility. We evaluated the outcomes of pediatric patients after OSS for non-neoplastic and benign neoplastic ovarian lesions.
Methods: A retrospective review was performed on children under 18 years of age who underwent ovarian sparing surgery for benign ovarian lesions from 2003-2012. Data collected included demographics, operative details, post operative course, and subsequent surgical intervention. Post-operative menstruation was documented as a potential indicator of intact ovarian function.
Results: One hundred and nine patients underwent OSS with a median age of 13.4 years (IQR 11.4 -15.1 years). Eighty-two patients were treated laparoscopically with 4 conversions to open. Twenty-seven had open procedures. Postoperative complication of surgical site infection occurred in 7 patients (6%). Pathology most commonly revealed functional ovarian cysts (n=57) and mature teratomas (n=37). Ninety-two patients (84%) were followed for a median of 10.6 months (IQR 0.72 -30.8 months). Fifty-five patients (60%) had subsequent imaging surveillance a median of 7.3 months postoperatively (IQR 3.9 -13 months). Twenty-one patients (38%) developed a second lesion within a median time of 11 months (IQR 7.7 -24 months). This rate was not significantly different for the benign neoplastic compared to the non-neoplastic lesions (28% vs. 47%, p = 0.15). Nine patients (10%) underwent reoperation for mass enlargement or persistent abdominal pain within a median time of 12.2 months (IQR 8.2 -44.5 months). Fifty-eight (63%) patients had begun or resumed menses at their most recent follow up. Three patients were able to conceive after OSS with a median lapse time of 5 years (range 2.4-6.7 years).
Conclusion: Benign ovarian lesions in children can be treated successfully with ovarian sparing surgery with low recurrence and reoperation rates while preserving ovarian function in the majority of patients. Longer follow-up is needed to determine the utility of menstruation as a predictor of fertility.