Experience of surgical management of ovarian masses in pediatrics in two pediatric hospitals in the city of Bogotá between 2019-2024.

Abstract

Introduction: At the national level, there are no standardized protocols or management guidelines for pediatric patients with ovarian tumors. This situation has led to heterogeneous and variable approaches among different institutions, leading to invasive and oncological surgeries in patients with a high probability of presenting a benign pathology. The purpose of this study is to characterize patients with ovarian masses in two reference pediatric hospitals in the city of Bogotá, Colombia, in order to describe the clinical characteristics, the initial approach, the surgical management, and the final histopathology. This could represent the initial step toward creating standardized protocols in the future to improve decision-making regarding the management of these patients.

Methods: A descriptive cross-sectional observational study was carried out in two reference pediatric institutions. A review of medical records was performed for the evaluation and analysis of demographic, clinical, paraclinical, surgical, and histopathological variables of patients under 18 years of age operated on with a diagnosis of ovarian tumor.

Results: A total of 127 patients under 18 years of age were obtained, with an average age of 14 years. Abdominal pain was identified as the most frequent symptom. Likewise, it was evidenced that malignant tumors tend to have a larger size in ultrasound, tomography, and during intraoperative findings. On the other hand, the tumor markers most related to malignancy were AFP and β-hCG. Regarding surgical management, it was observed that benign pathology was mostly treated by laparoscopy with ovary-sparing surgery, while patients with suspected malignancy were treated by open surgery with oncological staging. The final histopathological result found 88% benign tumors, a percentage similar to that reported in current literature.

Conclusions: The behavior and outcomes of ovarian pathology in the hospitals selected for the study were similar to those reported by global literature. Additionally, it was evidenced that there could be a relationship between tumor size, tumor markers, and the risk of malignancy. There is a growing trend toward performing less invasive surgeries; however, multicenter, prospective, and long-term studies are required to develop evidence-based management guidelines that help medical personnel make decisions to improve the approach for these patients.