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Treatment and Outcomes of Congenital Ovarian Cysts: A Study by the Canadian Consortium for Research in Pediatric Surgery (CanCORPS).

OBJECTIVE
We conducted a multi-centre study to assess treatments and outcomes in a national cohort of infants with congenital ovarian cysts.


SUMMARY BACKGROUND DATA
Wide variability exists in the treatment of congenital ovarian cysts. The effects of various treatment strategies on outcomes, specifically ovarian preservation, are not known.


METHODS
Female infants diagnosed with congenital intra-abdominal cysts between 2013-2017 at 10 Canadian pediatric surgical centres were retrospectively evaluated. Sonographic characteristics, median time to cyst resolution, incidence of ovarian preservation, and predictors of surgery were evaluated. Subgroup analyses were performed in patients with complex cysts and cysts ≥40 mm in diameter.


RESULTS
The study population included 189 neonates. Median gestational age at diagnosis and median maximal prenatal cyst diameter were 33 weeks and 40 mm, respectively. Cysts resolved spontaneously in 117 patients (62%), 14 (7%) prenatally and the remainder at a median age of 124 days. Intervention occurred in 61 patients (32%), including prenatal aspiration (2, 3%), ovary-sparing resection (14, 23%) or oophorectomy (45, 74%). Surgery occurred at a median age of 7.4 weeks. Independent predictors of surgery included postnatal cyst diameter ≥ 40 mm (OR 6.19, 95% CI 1.66 - 35.9) and sonographic complex cyst character (OR 63.6, 95% CI 10.9 - 1232). There was no significant difference in the odds of ovarian preservation (OR 3.06, 95% CI 0.86 - 13.2) between patients who underwent early surgery (n = 22) and those initially observed for at least 3 months (n = 131).


CONCLUSION
Most congenital ovarian cysts are asymptomatic and spontaneously resolve. Early surgical intervention does not increase ovarian preservation.