Surgery of germ cell tumours of the ovary

Abstract

The surgical management of germ cell tumours of the ovary is based on the premise of preserving fertility. Ovarian germ cell tumours occur in young women in whom fertility preservation is of great concern. Overwhelmingly ovarian germ cell tumours are benign, the most common form of which is the benign cystic teratoma (dermoid cyst). Cystectomies with preservation of the ovarian remnant should be the routine surgical treatment of benign cystic teratomas. Management of ovarian germ cell malignancies also focuses on preservation of fertility. These tumours, with the exception of dysgerminoma are overwhelmingly unilateral. All are exquisitely sensitive to cytotoxic chemotherapy and fertility has been preserved and successful conception has occurred even in women with advanced stage disease following surgery and chemotherapy. Cytoreductive surgery plays a role in the treatment of non-dysgerminomatous ovarian germ cell malignancies, but is not necessary for the management of ovarian dysgerminomas as the latter are exquisitely sensitive to chemotherapy. Second-look surgery is no longer routinely recommended in the management of these disorders due to the low incidence of positivity when patients have been treated with modern combination chemotherapy. The role of surgery in the management of recurrent disease has yet to be established due to the low incidence of persistent disease following modern combination chemotherapy.