Standardizing the surgical management of benign ovarian tumors in children and adolescents: A best practice Delphi consensus statement

Abstract

Aim No widely agreed consensus protocols exist for the management of benign ovarian tumors (BOT) in children. This presents a substantial risk for suboptimal management. We aimed to generate multispecialty consensus guidance to standardize surgical management and provide a clear follow‐up protocol for children with BOTs. Methods Prospective two‐round confidential e‐Delphi consensus survey distributed among multispecialty expert panel; concluded by two semistructured videoconferences. Main results Consensus was generated on these core outcome sets: preoperative/intraoperative management; follow‐up; adolescent gynecology referral. (1) Children with BOTs should receive the same management as other patients with potentially neoplastic lesions: Preoperative discussion at a pediatric oncology multidisciplinary meeting to risk stratify tumors, and management by health professionals with expertise in ovarian‐sparing surgery and laparoscopy. (2) Ovarian‐sparing surgery for BOTs should be performed wherever possible to maximize fertility preservation. (3) Ovarian masses detected during emergency laparoscopy/laparotomy should be left in situ wherever feasible and investigated appropriately (imaging/tumor markers) before resection. (4) Follow‐up should be undertaken for all patients after BOT resection. Patients should be offered referral to adolescent gynecology to discuss fertility implications. Conclusion This best practice Delphi consensus statement emphasizes the importance of managing children with BOTs through a well‐defined oncological MDT strategy, in order to optimize risk stratification and allow fertility preservation by ovarian‐sparing surgery wherever possible.

Comment on Pediatr Blood Cancer. 2022;e29589. Standardizing the surgical management of benign ovarian tumors in children and adolescents: A best practice Delphi consensus statement.

“…We read with interest the article from Braungart and colleagues, discussing management of young females with benign ovarian tumors [1]. This is important and timely, and we agree with the need for clarity in management of this under-investigated group.…”

“…importance of multidisciplinary team (MDT) discussion to optimise management and risk-stratification [1]. They highlight the importance and safety of ovarian-sparing-surgery in benign tumors, to preserve fertility and avoid long-term effects including premature ovarian failure [1].…”

“…. pediatric oncologists representing CCLG Germ Cell Tumour Group' [1]. Unfortunately, there was no pediatric oncologist involvement from the group in formulating the statements for discussion.…”

“…The surgical guidance is useful; however, a size cut-off for minimally invasive surgery is specified, without supportive evidence [1]. Another incongruity is for tumor marker follow-up (section 2.3, bullet 7) if they were elevated preoperatively; by definition this group should have had normal markers at diagnosis (section 2.1, first paragraph) [1].…”

“…In addition, no reference is provided here to existing guidelines [7]. The recommended two-year interval between ultrasounds [1] is therefore neither evidence-based nor considers the patient/parent opinion. Furthermore, there is no justification for gynecologic fertility referral following ovarian-sparing-surgery where subsequent ultrasound shows normal ovarian reserve bilaterally.…”