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abstract
Purpose
Historically, surgical
staging practices for pediatric malignant ovarian tumors mirrored adult
guidelines. In 2004, the Children's Oncology Group (COG) developed
guidelines specific to pediatric patients with ovarian germ cell tumors.
We sought to characterize the operative management of pediatric ovarian
lesions and adherence to COG surgical staging guidelines.
Methods
We
conducted a single institution, retrospective study of pediatric
patients who underwent surgical intervention for ovarian lesions between
1995 and 2012. The primary outcome was adherence to COG staging
guidelines.
Results
Among 502 patients, 44
(8.8%) had malignant ovarian tumors. Two patients (2/44, 4.5%) underwent
correct surgical staging. Therefore, 95.5% (42/44) underwent incorrect
surgical staging by omitting recommended maneuvers (surgical
understaging) or performing clinically unnecessary surgical staging
steps (surgical overstaging). Of the 42 patients with incorrect surgical
staging, 85.7% (36/42) were surgically overstaged and 76.2% (32/42)
were surgically understaged. In the entire cohort, 12 (27.3%) patients
had complete staging procedures, including 10 surgically overstaged
patients (10/12, 83.3%). Staging practices were not significantly
different before and after the release of the 2004 COG guidelines.
Conclusion
Incorrect
surgical staging of pediatric ovarian malignancies is commonplace.
These data stress the need for greater education among all surgeons
caring for children with malignant ovarian tumors.
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