Controversies in the management of ovarian tumours in prepubertal children — A BAPS and UK CCLG Surgeons Cancer Group National Survey
Sarah Braungarta, Ross J. Craigiea, Paul D. Lostyb,c
aDepartment of Paediatric Surgery, Royal Manchester Children’s Hospital, Manchester,UK
bDepartment of Paediatric Surgery, Alder Hey Children’s Hospital NHS Foundation Trust, Liverpool,UK
cInstitute of Child Health University of Liverpool, Liverpool, L693BX,UK
Background: No clear treatment and follow-up protocols have been established for prepubertal patients with ovarian tumours. The lack of adequate prospective data in the literature includes all aspects of their management. A significant number of children with ovarian masses present out of hours as a surgical emergency and are initially managed by paediatric surgeons without special interest in surgical oncology. Clear guidance on the man- agement of such tumours is therefore fundamental. We hypothesised that – owing to the lack of clear guidelines – the current approach to prepubertal ovarian tumours amongst paediatric surgeons is highly heterogenous.
Methods: An eleven-item multiple choice questionnaire was distributed amongst all BAPS consultant paediatric surgeons in the UK and simultaneously to all paediatric surgical oncology members of the UK Children’s Cancer and Leukaemia Group in order to survey the management of ovarian masses in children. We aimed to compare the management approaches in both groups.
Results: 63 consultants participated in the survey; 49% with a special interest in surgical oncology, 48% with dif- ferent subspecialty interests. The majority of participants (56%) performed 1–5 operations on ovarian tumours per year. Preoperative imaging of choice for the oncology surgeons was US and MRI (77.3%) versus 41.4% in the group of surgeons with different special interests. Surgeons with different special interests were more likely to request Ca125 as a preoperative tumour marker (62.1% vs 32.3%). 19.3% of oncology surgeons, and 27.6% of surgeons with other special interest stated they would never remove an ovarian tumour via the laparoscopic ap- proach. Follow-up practise was highly variable amongst survey participants in both surgeon groups regarding frequency, duration and further investigations during follow-up. Almost 50% of participants follow their patients up according to personal practice protocols.
Conclusion: This first national survey on the management of prepubertal ovarian tumours demonstrates great heterogeneity in the current approach amongst UK paediatric surgeons. Better evidence is needed to formulate clear guidance for the management of such tumours. We propose instigation of a multicentre registry for ovarian tumours to generate prospective data and clarify guidance for the future.
Dear BAPS Member
We would greatly appreciate your response to this survey on the management of ovarian tumours in childhood.
There is currently no standardized approach to the management of ovarian tumours in children. Adequate prospective data to facilitate the development of guidelines does not exist. This dilemma remains a point of ongoing discussion at the surgical meeting of the Children’s Cancer and Leukaemia Group (CCLG).
This survey aims to investigate the current management of ovarian tumours by Paediatric Surgeons in the UK. Children with ovarian masses frequently present out of hours – be it with a newly diagnosed mass, or symptoms of ovarian torsion and their initial management is often undertaken by paediatric surgeons without a special interest in surgical oncology. It is therefore very important to capture the views of all paediatric surgical Consultants in the UK, not only those with a special interest in surgical oncology. The results will enable us to ascertain whether there is a need to establish a more standardized approach to the management of such tumours.
Many thanks for your participation.
Sarah Braungart (ST3 Paediatric Surgery, Manchester Children’s Hospital)
Ross J Craigie (Consultant Paediatric Surgeon, Manchester Children’s Hospital)
Professor Paul Losty (Professor of Paediatric Surgery, Chair of the CCLG Surgeons’ Subgroup, Alder Hey Children’s Hospital)