15. Surgical management of ovarian dermoid cysts in children: a systematic review and meta-analysis

Background

Ovarian dermoid cysts are benign germ-cell tumors commonly found in pediatric and adolescent patients. Laparoscopic ovarian cystectomy has become the preferred surgical approach over laparotomy due to its benefits of shorter hospital stay, reduced post-operative pain, and quicker recovery. However, there remains concern for higher rates of cyst rupture (and possible peritonitis) and future dermoid cyst recurrence, when compared to laparotomy. This systematic review and meta-analysis evaluates the existing evidence on these surgical methods to assess whether the shift to laparoscopy has led to these unintended outcomes.

Methods

A comprehensive literature search in five academic medical databases was conducted with an information specialist, using keywords and MeSH terms for ovarian dermoid cysts, laparotomy, laparoscopy, or minimally invasive surgery in children, from database inception to August 29, 2024. This study was exempt from Research Ethics Board (REB) approval. Randomized, quasi-randomized trials, and prospective/retrospective cohort studies were eligible. Two independent authors reviewed titles/abstracts, full texts, and extracted data, resolving conflicts with a third author as required. Risk of bias was assessed with appropriate tools. A meta-analysis using risk ratios with 95% confidence intervals was performed with a Mantel-Haenszel fixed-effect model. Heterogeneity among studies was assessed by I², with I2 > 50% interpreted as high degree of heterogeneity requiring random-effects modelling.

Results

1021 title/abstracts were reviewed, with six studies eligible for inclusion (2000 – 2022; Canada, United States, Poland). In total, 492 (58%) patients underwent laparoscopy and 353 (42%) underwent laparotomy. For meta-analysis, five studies were included for cyst rupture and four studies were included for dermoid cyst recurrence. Random-effect meta-analysis (I2=58%) showed a significantly higher risk of cyst rupture with laparoscopy (RR = 2.47, 95% CI 1.40-4.37). Four studies reported on peritonitis, with no cases observed. Fixed-effect meta-analysis (I2 =5%) found no significant difference in dermoid cyst recurrence between laparoscopy and laparotomy (RR = 0.92, 95% CI 0.41-2.08).

Conclusions

Laparoscopy remains the preferred approach for the surgical management of ovarian dermoid cysts in children. Despite a higher risk of intraoperative cyst rupture, our systematic review highlights that

subsequent post-operative peritonitis was not clinically observed. Further, dermoid cyst recurrence rates remained similar between laparoscopy and laparotomy, further encouraging the use of laparoscopy when possible. Limitations of our systematic review include the limited number of included studies, all of which were observational studies with small sample sizes, and the presence of unaccounted confounders such as cyst size, patient age and BMI, and varying indications for surgical management.