Timothy B. Lautz

Ovarian sparing surgery can be achieved for many pediatric patients with giant adnexal cystic masses

Ovarian-sparing surgery (OSS) is the surgical treatment of choice for benign ovarian tumors in children, but OSS can be technically challenging in the setting of giant ovarian cystic masses as ovarian tissue can become thinned or stretched. We aim to clarify if OSS is a feasible approach to giant ovarian cystic masses in children and if morphologically normal appearing ovarian tissue can be detected on post-operative imaging following OSS. We performed a retrospective review of all adnexal surgical procedures at a single children's hospital from 2015 to 2023. Children undergoing surgery for an adnexal cystic mass ≥15 cm in size were included. We report surgical approach, identification of ovarian tissue on post-operative ultrasound, and recurrence rate. Univariate analysis was performed for all data points. We identified 55 patients who underwent surgery for adnexal cystic masses ≥15 cm. The median age of patients was 15.0 years (Range: 10.4-20.5 years). Of the 55 patients, 40 (72.7 %) were pre-operative candidates for OSS. Of these 40 patients, 25 (62.5 %) underwent OSS. The remaining 15 (37.5 %) had either significantly thinned and unidentified ovarian tissue intraoperatively (N = 11), non-viable ovarian torsion (N = 1), adhesive disease preventing OSS (N = 1), intra-operative concern for malignancy (N = 1), or elected for oophorectomy (N = 1). All 22 patients who underwent post-operative doppler ultrasound following OSS had morphologically normal appearing and perfused ovarian tissue on imaging. OSS resulted in 1 local recurrence of serous cystadenoma. Children with giant ovarian cystic masses and a benign pre-operative risk stratification are a population of patients with opportunity for meaningful ovarian salvage. IV - Retrospective Cohort Study.