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Failure of Operative Therapy after Ovarian-Sparing Surgery for Pediatric Benign Ovarian Neoplasms: A Retrospective
Maria E Knaus1, Amanda J Onwuka2, Naila M Abouelseoud3
1Center 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.
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.
Insights
Ovarian-sparing surgery for pediatric benign ovarian neoplasms had a low failure rate of 7.5% for incomplete tumor removal. Most patients achieved successful tumor removal, and some suspected recurrences resolved with monitoring.
Area of Science:
- Pediatric surgery
- Gynecologic oncology
- Benign ovarian neoplasms
Background:
- Ovarian-sparing surgery is increasingly utilized for benign ovarian neoplasms in pediatric patients.
- Evaluating the success of initial operative therapy is crucial for optimizing patient outcomes.
Purpose of the Study:
- To assess the failure rate of initial operative therapy, defined as incomplete tumor removal, following ovarian-sparing surgery for pediatric benign ovarian neoplasms.
Main Methods:
- A retrospective review was conducted on patients up to 21 years old who underwent ovarian-sparing surgery for benign ovarian neoplasms between 2010 and 2016.
- Failure was defined as a radiologically suspected or pathologically confirmed ipsilateral lesion with the same pathology within 12 weeks of the initial operation.
Main Results:
- Of 40 patients with imaging within 12 weeks, 16 (40%) had an ipsilateral ovarian abnormality, and 5 were suspected of having the same lesion.
- Three patients (7.5%) had pathologically confirmed incomplete tumor removal, while 2 showed lesion resolution with serial imaging.
- No significant association was found between patient/surgical factors and therapy failure.
Conclusions:
- Ovarian-sparing surgery for pediatric benign ovarian neoplasms demonstrates a low failure rate for complete tumor removal.
- Serial monitoring may be appropriate for selected patients with suspected incomplete tumor removal on initial imaging, potentially avoiding repeat surgery.
