Laparoscopic Surgery for Pediatric Malignant Ovarian Germ Cell Tumors After Neoadjuvant Chemotherapy: A Single-Center Retrospective Study.

Purpose: The purpose of this study was to evaluate the clinical effects and safety for cancer treatment of neoadjuvant chemotherapy (NACT) when combined with laparoscopic fertility-sparing (anatomical preservation) surgery in pediatric patients who have large malignant ovarian germ cell tumors (MOGCTs).

Methods

We performed a retrospective analysis on seven young female patients with a median age of 8.8 years (range: 10 months to 13.4 years). The patients were treated between 2015 and 2023, and all of them received two to three cycles of JEB (carboplatin, etoposide, and bleomycin) regimen as NACT. After the NACT, these patients had laparoscopic (n = 7) unilateral salpingo-oophorectomy.

Results

Neoadjuvant chemotherapy (NACT) achieved a median reduction in tumor volume of 91% (range: 85% to 97%). All the procedures were completed successfully and there was no need to convert to open surgery. The median operative time was 85 min (range: 70 to 120 min), and the blood loss was minimal. The median blood loss was 10 mL, with a range of 5 to 50 mL. In patients with yolk sac tumors, alpha-fetoprotein (AFP) levels returned to normal within a median of 20 days after the operation. With a median follow-up of 54 months (range: 18 to 118 months), all the patients had 100% disease-free survival.

Conclusions

This study suggests that NACT combined with laparoscopic fertility-sparing (anatomical preservation) surgery may be effective and appears promising for selected pediatric patients with MOGCTs.