Safety of laparoscopic oophorectomy in a Dutch national pediatric cancer cohort

Abstract

Objective: To report our experiences on the safety of laparoscopic oophorectomy (LO) for ovarian tissue cryopreservation in childhood cancer (CC) patients. Design: Descriptive study of a prospectively registered cohort. Subjects: All CC patients undergoing LO in the Netherlands from November 2020 until April 2024. Exposure: Laparoscopic oophorectomy for means of fertility preservation before or during gonadotoxic treatment. Main Outcome Measures: Safety, including procedure-related complications, such as critical events (desaturation, bradycardia), need for mechanical ventilation in a pediatric intensive care unit (PICU), site infections, hemorrhage, and survival, scored according to Clavien Dindo (CD) classification. Results: Eighty-eight patients, median age 6.5 years (range 1–18 years) underwent LO, of which 2/88 patients developed CD grade 4, 1/88 CD grade 3, and 8/88 CD grade 2 complications, with the most common being port site infection (6%) and bleeding (6%). No clear determinant could be identified as a risk factor for complications. All patients recovered from procedure-related complications and no patient died as a consequence of oophorectomy. Conclusion: Laparoscopic oophorectomy is a relatively safe procedure to preserve future fertility for girls with cancer with a high risk of gonadal failure and consequent infertility. However, LO can be accompanied by complications in children with cancer. Therefore, safety monitoring and identification of risk factors for complications based on larger cohorts in future studies are needed. Prevention of complications of LO is an important obligation to balance the future benefits against the risks of LO to enhance the future chance of pregnancy for girls with cancer.