Ovarian germ cell tumor surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Overview

Surgical intervention is the mainstay of management of ovarian germ cell tumors. Surgery is recommended both for staging and choosing appropriate treatment approaches. accordingly. Surgical management of the ovarian germ cell tumors, for the purpose of treatment, classified to two categories according to the preference of the patient to preserve the ovary or not.

Surgery

• Surgery is the mainstay of management of ovarian germ cell tumors.
• Surgery is recommended both for staging and choosing appropriate treatment approaches. accordingly.
• Surgical options depends upon the choice of preserving fertility.

Management of Mature Teratoma
Mature Teratoma	Surgery is the mainstay of treatment for mature teratoma. Nonsurgical management may be considered in those with tumors smaller than 6 cm, especially those who is planning to get pregnant. Surgery increases the risk of band adhesion formation that may be associated with future infertility in women. Surgery is usually reserved for patients with either: Tumor size larger than 6 cm No plans for future pregnancy Post-menopausal women
Management of Dysgerminomas
Stage I ovarian germ cell tumors	Unilateral salpingo-oophorectomy with or without lymphangiography or computed tomography (CT) Unilateral salpingo-oophorectomy followed by observation Unilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy Unilateral salpingo-oophorectomy with conservation of uterus and contralateral ovar is indicated in those who plan for future pregnancies. Postoperative lymphangiography or CT is indicated for those who have not had the careful surgical and pathological examination of pelvic and para-aortic lymph nodes during surgery. Patients with surgically staged stage IA tumors may be observed carefully after surgery without the need for adjuvant treatment. Patients with incompletely staged tumor through surgery or those with higher stages may need adjuvant treatment.
Stage II ovarian germ cell tumors	Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy Unilateral salpingo-oophorectomy with adjuvant chemotherapy This option is considered for younger patients and those who desire to preserve their fertility for future pregnancies. Radiotherapy has been associated with ovarian failure. Adjuvant chemotherapy with the platinum-based regimen has replaced radiation therapy except in the rare patient in whom chemotherapy is not considered appropriate.
Stage III ovarian germ cell tumors	Unilateral salpingo-oophorectomy with adjuvant chemotherapy Second-look laparotomy This strategy is not beneficial in patients with completely resected tumors who receive cisplatin-based adjuvant treatment. Second-look surgery may be beneficial in those whose tumor was not completely resected at the initial surgical procedure and who had teratomatous elements in their primary tumor.
Stage IV ovarian germ cell tumors	Total abdominal hysterectomy and bilateral salpingo-oophorectomy Unilateral salpingo-oophorectomy with adjuvant chemotherapy Chemotherapy is the preferred treatment in the patient who wants to preserve fertility.

Management options of Other Ovarian Tumors

Surgical options for other ovarian tumors
Stage I ovarian germ cell tumors	Unilateral salpingo-oophorectomy with adjuvant chemotherapy Unilateral salpingo-oophorectomy followed by observation Unilateral salpingo-oophorectomy with conservation of uterus and contralateral ovar is indicated in those who plan for future pregnancies. Chemotherapy is usually done postoperatively in those with ovarian germ cell tumors other than pure dysgerminoma and low grade (grade 1) immature teratoma, but it can also preserved for those whose tumors relapse after the surgery.
Stage II ovarian germ cell tumors	Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy Unilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy Second-look laparotomy
Stage III ovarian germ cell tumors	Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy Unilateral salpingo-oophorectomy with adjuvant chemotherapy
Stage IV ovarian germ cell tumors	Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy Unilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy

• Unilateral salpingo-oophorectomy with adjuvant chemotherapy
• Unilateral salpingo-oophorectomy followed by observation
• Unilateral salpingo-oophorectomy with conservation of uterus and contralateral ovar is indicated in those who plan for future pregnancies.
• Chemotherapy is usually done postoperatively in those with ovarian germ cell tumors other than pure dysgerminoma and low grade (grade 1) immature teratoma, but it can also preserved for those whose tumors relapse after the surgery.

• Other germ cell tumors

• Dysgerminomas

• Other germ cell tumors

• Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy
• Unilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy
• Second-look laparotomy

• Dysgerminomas

• Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy
• Unilateral salpingo-oophorectomy with adjuvant chemotherapy

• Other germ cell tumors

• Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy
• Unilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy

References

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