The purpose of this review is to outline ovarian conservation and fertility sparing surgery (FSS) in the management of the most common pediatric gynecology malignancies.
Management of gynecologic malignancies has evolved to have a greater appreciation for adverse late effects from radical surgery, chemotherapy, and radiation. A growing body of literature has led to a paradigm shift toward ovarian conservation and FSS in the management of pediatric ovarian malignancies and genitourinary rhabdomyosarcoma (RMS). The role of minimally invasive surgery is still being explored but guidelines support this approach as a viable option for early stage ovarian cancers when performed by skilled surgeons. Research continues to address settings in which adjuvant chemotherapy for ovarian cancer can be avoided. Treatment for genitourinary RMS has transitioned from radical surgery to a conservative multimodal approach with FSS, systemic chemotherapy, and targeted radiation.
FSS and ovarian conservation are emerging concepts in the management of gynecologic malignancies in young women. Conservative surgical approaches and avoidance of gonadotoxic chemotherapy and radiation to minimize acute and long-term complications while maintaining efficacy are important considerations. Fertility preservation techniques continue to evolve and offer young women the opportunity for future fertility and preservation of ovarian function.
aDivision of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
bDivision of Gynecologic Specialties, Pediatric and Adolescent Gynecology, Department of Gynecology and Obstetrics, Emory University School of Medicine
cDivision of Pediatric Surgery and Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
Correspondence to Krista J. Childress, MD, Division of Gynecologic Specialties, Pediatric and Adolescent Gynecology, Department of Gynecology and Obstetrics, Emory University School of Medicine, 1400 Tullie Rd. NE, Floor 7, Atlanta, GA 30309, USA; Division of Pediatric Surgery and Pediatrics, Children's Healthcare of Atlanta, 1975 Century Blvd NE Suite 6, Atlanta, GA 30345, USA. Tel: +1 630 464 2689; e-mail: firstname.lastname@example.org