Background: Ovarian mature teratomas (OMTs) are the most common benign ovarian tumors in pediatric patients. Management in adolescents can be performed by pediatric (PSs) or gynecologic surgeons (GSs). The aim of this study was to assess the differences in OMT management and the repercussions according to the risk of secondary events. Design: We compared patients aged 14 to 18 who underwent surgery for OMT between 2009 and 2022 from the French national pediatric database of OMTs with patients managed by GSs at a regional scale. Results: 119 patients were included (80 by PSs, 39 by GSs). Differences between teams were noted: (i) tumor marker analysis is systematic by PSs (80%, n = 72) but rare by GSs (18%, n = 7), (ii) PSs mostly carried out a laparotomy (78%, n = 62), whereas GSs preferred laparoscopy (90%, n = 35), (iii) per operative rupture was more frequent by GSs (56%, n = 22) than PSs (10%, n = 8), (iv) median duration of follow-up increased by PSs (20 months) versus 1 month by GSs. Ten second events (13% by GSs (n = 5), 6% by PSs (n = 5)) occurred in nine patients, without significant differences. Conclusion: A notable difference exists in the management of OMTs between PSs and GSs who may overlook a malignant component in germ cell tumors in adolescents and the risk of metachronous recurrence, however reported up to 10-20%. Compliance to SIOPE 2020 is recommended to avoid rupture of potential malignant tumor and to preserve fertility.

Objective Ovarian mature teratoma (OMT) is a common ovarian tumor found in the pediatric population. In 10% to 20% of cases, OMT occurs as multiple synchronous or metachronous lesions on ipsi- or contralateral ovaries. Ovarian sparing surgery (OSS) is recommended to preserve fertility, but total oophorectomy (TO) is still performed. This study reviews the clinical data of patients with OMT, and analyzes risk factors for second events. Design A retrospective review of all girls under 18 years of age with OMTs was performed. Data on clinical features, imaging, laboratory studies, surgical reports, follow-up second events and their management were retrieved. Results Overall, 350 children were identified. Eighteen patients (5%) presented with a synchronous bilateral form at diagnosis. Surgery was performed by laparotomy (85%) and laparoscopy (15%). OSS and TO were performed in 59% and 41% of cases respectively. Perioperative tumor rupture occurred in 23 cases, independently of the surgical approach. Twenty-nine second events occurred (8.3%) in a median time of 30.5 months from diagnosis (ipsilateral: 8 cases including one malignant tumor, contralateral: 18 cases, both ovaries: 3 cases). A large palpable mass, bilateral forms at diagnosis and perioperative rupture had a statistical impact on the risk of second event, whereas type of surgery or approach did not. Conclusion This study is a plea in favor of OSS as the first choice of treatment of OMT when possible. Close follow-up during the first five years is mandatory considering the risk of 8.3% of second events especially in cases with risk factors.