Significance of ultra-radical surgery in extensive metastatic ovarian growing teratoma syndrome

Introduction: To evaluate the perioperative risks and outcomes of ultra-radical surgery in patients with extensive metastatic ovarian growing teratoma syndrome (GTS). Methods: We conducted a retrospective study of patients with extensive metastatic ovarian GTS treated in our hospital between 2000 and 2022. Patients' clinical characteristics, surgical treatment, and outcomes were evaluated. Results: Overall, 13 patients were identified and the median age at diagnosis of ovarian immature teratoma (IT) was 24 years (range: 5 - 37). The median interval between IT diagnosis and presenting GTS was 8 months (range: 2 - 60), with a median surgery delay of 5 months (range: 3 - 300). Peritoneum and liver were the most commonly affected site (100%), followed by bowel (12 patients, 92.3%), diaphragm (12 patients, 92.3%), adnexa (9 patients, 69.2%), omentum (8 patients, 61.5%), uterus (7 patients, 53.8%), in the descending order. The mean operation time was 316 min (range: 180 - 625), and the mean blood loss volume was 992 ml (range: 200 - 5000). Peritoneal metastasectomy (13 patients, 100%), diaphragmatic metastasectomy (12 patients, 92.3%), metastases removal from the bowel (8 patients, 61.5%), partial hepatectomy (4 patients, 30.8%), bowel excision and anastomosis (1 patient, 7.7%) were also applied to achieve optimal debulking. R0 was achieved in 9 (69.2%) patients. A high rate of intraoperative blood transfusion (8 patients, 61.5%) and admission to the intensive care unit (9 patients, 69.2%) were observed, and the median postoperative hospitalization time was 8 days (range: 4 - 22). After a median follow-up of 3.3 years, 9 patients were free of disease and 4 were alive with stable residual diseases. Conclusion: The survival outcomes in extensive metastatic ovarian GTS were satisfactory after ultra-radical surgery, while a proper therapeutic plan should be established due to the high perioperative risks.