WOFAPS 2025 8th World Congress of Pediatric Surgery

İlayda Başar Aksu ¹, Ayten Ceren Bakır ¹, Damat Baghishov ², Nurşah Eker ², Gürsu Kıyan ¹, Kıvılcım Karadeniz Cerit ¹

¹ Marmara University Faculty of Medicine, Department of Pediatric Surgery, Istanbul
² Marmara University School of Medicine, Department of Pediatric Oncology, İstanbul

Purpose: In contrast to adults, most ovarian neoplasms in children are benign, with only 10-20% malignancy. As a result, ovarian sparing surgery (OSS) has become an increasingly favored approach to preserve fertility in children. This study presents our 14 year institutional experience with OSS, focusing on its feasibility, safety and oncologic outcomes.

Methods: We retrospectively reviewed the medical records of 140 pediatric patients who underwent surgical intervention for ovarian masses between June 2011 and June 2025. 7 patients had missing data and excluded from the study. Clinical data including demographics, clinical presentation (abdominal pain, palpable mass, ovarian torsion), imaging modalities (ultrasonography, CT, MRI), tumor markers (AFP, β-HCG, CA-125, CA 19-9, CEA, Inhibin A/B), surgical approach (laparoscopic vs open), type of procedure (OSS, oophorectomy, salpingo-oophorectomy), and histopathological diagnoses were analyzed.

Results: Among the 133 patients, 120 (90%) had benign lesions and 13 (10%) were diagnosed with malignant tumors. The most common benign lesion was mature cystic teratoma (n=42). Malignancies comprised dysgerminoma, juvenile granulosa cell tumor, gonadoblastoma and immature teratoma. OSS was successfully performed in 105 patients, with benign pathology confirmed in 98% of these cases. In two patients, OSS was initially performed for lesions later identified as dysgerminoma; both subsequently underwent salpingo-oophorectomy, with no recurrence observed during follow-up. While OSS was initially performed concurrently with detorsion of the ovaries, recent practice has shifted toward a delayed, two-step approach following preoperative risk stratification based on imaging and tumor markers.

Conclusion: Given the 10–23% reported risk of developing metachronous neoplasms in the contralateral ovary and accidental castration, long-term surveillance remains essential in pediatric patients with ovarian masses. OSS represents a safe and effective fertility-preserving strategy in appropriately selected patients. Nonetheless, the potential risk of upstaging a misdiagnosed malignant tumor and under-treatment necessitates careful preoperative evaluation.