CONTROLLED ASPIRATION OF LARGE PAEDIATRIC OVARIAN CYSTIC TUMOURS
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In brief
In brief
Study of 23 girls with large ovarian cystic masses demonstrates safe controlled aspiration technique using tissue glue and sterile draping, enabling cosmetic pfannenstiel incision without tumor spillage. Ovarian-sparing surgery achieved in 74% of cases across diverse pathologies including teratomas and malignancies.
Written by the GCMD Library team from the article.
Aim
Cystic ovarian masses in children may be physiological or neoplastic. It is mandatory that suspected neoplastic lesions are resected without tumour spillage. However, a large midline incision is cosmetically unappealing incision to young women. Here we describe our experience of using controlled drainage without spillage that allows a cosmetic pfannenstiel approach without compromising oncological principles.
Method
All girls treated with large ovarian cystic masses since 2008 in our centre were identified and data was collected prospectively.
A small pfannenstiel incision was performed followed by peritoneal washings; tissue glue was used to stick an Opsite™ dressing to the cyst surface and fluid drained so there was no leakage back into the patient. Once aspirated the cyst was delivered and an ovarian preserving cystectomy was performed where possible.
Results
Twenty-three girls (median age 14.5 years(8.1 to 16.5 years) were included. Pre-operative MRI scan showed a complex lesions with median volume of 1169ml(range 252 – 7077ml). At surgery 22/23 cysts were intact and removed without spillage. Histology: mature teratoma(11), serous cyst(3), mucinous cyst adenocarcinoma(2), mucinous cystadenoma(5), Sertoli-Leydig tumour, sclerosing stromal tumour. One girl with pre-operative rupture of a mucinous adenocarcinoma subsequently died. Ovarian sparing cystectomy was performed in 17/23 girls. All other patients are well without evidence of recurrence.
Conclusion
This is the largest series in children and adolescents using controlled drainage of cystic ovarian tumours. Though there were a range of diagnoses we have shown that these can be removed safely with a cosmetic pfannenstiel approach while following oncological principles.