Sarah Braungart1,2, Cara Williams2,3, Suren G Arul4, Katerina Bambang5, Ross James Craigie1, Kate Mary Cross6, Alistair Dick7, Philip Hammond8, Bruce Okoye9, Timothy Rogers10, Paul Damian Losty2,11, Adam Glaser12,13, Mark Powis14. 1. Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK. 2. Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK. 3. Department of Gynaecology, Liverpool Women's Hospital, Liverpool, UK. 4. Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK. 5. Department of Reproductive Medicine, Liverpool Women's Hospital, Liverpool, UK. 6. Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. 7. Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, UK. 8. Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, UK. 9. Department of Paediatric Surgery, St George's Hospital London, London, UK. 10. Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol, UK. 11. Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK. 12. Department of Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK. 13. Leeds Institute of Medical Research, University of Leeds, Leeds, UK. 14. Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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.
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.
Authors: Andrea Romano; Sun-Wei Guo; Jan Brosens; Asgerally T Fazleabas; Caroline Gargett; Stefan Giselbrecht; Martin Goette; Linda Griffith; Hugh S Taylor; Robert N Taylor; Hugo Vankelecom; Charles Chapron; Xiaohong Chang; Khaleque N Khan; Paola Vigano' Journal: Reprod Fertil Date: 2022-07-01