Medium-term Ovarian Volume and Anti-Müllerian Hormone After Ovarian-sparing Surgery for Benign Neoplasms in Pediatric Patients.

Background And Aims: Benign ovarian neoplasms are common in the pediatric population. In young adult women, oophorectomy has been shown to negatively impact long-term ovarian endocrine function. Recently, ovarian-sparing surgery (OSS) has been proposed as it offers similar results to oophorectomy in terms of recurrence rates. However, the impact of OSS on functional preservation in girls and adolescents remains unclear due to limited follow-up data. The aim of this study was to evaluate ovarian function and its morphological correlation in the medium term in girls undergoing OSS for benign neoplasms.

Methods: A retrospective cohort study was conducted including girls under 15 years of age who underwent OSS for benign neoplasms at our hospital between January 2014 and July 2022. Eligible patients were cited to an on-site evaluation at least 12 months after surgery. Data collected included age at surgery, tumor volume, history of adnexal torsion and recurrence. Postoperative ovarian volume was assessed by transabdominal pelvic ultrasound, and serum anti-Müllerian hormone (AMH) levels were measured and compared to expected values for age.

Results: Thirty-seven patients presented with 39 ovarian neoplasms; 31 underwent OSS. Mean age at surgery was 11.7 years, and mean period from surgery to face-to-face evaluation was 46.6 months. Excluding cases with ovarian torsion, normal ovarian volume (>-2 standard deviations (SD) from the expected value for age) was observed in 22/27 ovaries (81.5 %). In patients with normal volume ovaries after unilateral disease, 17/19 (89.5 %) AMH values were > -1SD from the expected value. A positive and statistically significant correlation was found between postoperative ovarian volume and AMH levels (Pearson correlation 0.52, p < 0.01). One patient who underwent oophorectomy and one who underwent OSS reported achieving pregnancy without medical intervention. No ipsilateral recurrences were observed during the follow-up period.

Conclusions: OSS is a viable alternative for treating benign neoplasms in girls, showing morphological and functional results comparable to healthy women from one-year post-intervention onwards. Long-term follow-up and prospective studies are needed to determine the effectiveness of OSS in maximizing fertility and avoiding premature menopause, which occurs after oophorectomy at an early age, while maintaining similar oncological outcomes.

Level Of Evidence: IV.