Work by a team of child health researchers from the RI-MUHC and across Canada provides new insights into treatment for fetal ovarian cysts

Ovarian cysts in female infants are some of the most common congenital anomalies seen by pediatric surgeons. Studies have estimated that one in 2,625 newborns present with some form of cystic abdominal mass. Although generally benign, fetal ovarian cysts can lead to complications. Many surgical interventions have been described. The outcomes and risks of these interventions have not been clearly documented in large-scale scientific studies, leading to significant variability in the care of these baby girls.

A research team led by Sherif Emil, MDCM, senior investigator in the Child Health and Development Program of the Research Institute of the McGill University Health Centre (RI‑MUHC), set out to determine the optimal standard of care for infants with congenital ovarian cysts.

In a new study published in Annals of Surgery, the team shared their finding that most fetal ovarian cysts resolve spontaneously. Additionally, the team found that surgery to remove the cysts did not promote ovarian salvage (i.e., saving the involved ovary), or avoid later complications. Reviewing five years of data from 11 Canadian hospitals, the researchers found that cysts that did not disappear spontaneously typically remained asymptomatic.

Data was collected from babies diagnosed with an ovarian cyst over a five-year period. The endpoints of data collection were resolution of the ovarian cyst, surgical intervention, or the patient reaching one year of age.

“This work is critically important because it will likely save hundreds, and eventually thousands, of newborn girls unnecessary surgery,” says Dr. Emil, who is also the director of the Harvey E. Beardmore Division of Pediatric Surgery at the Montreal Children’s Hospital. “Furthermore, it provides pediatricians and pediatric surgeons with an algorithm which they can use for follow up of these patients and decision-making regarding timing and type of intervention.”

This study is the largest publication on the subject to date, and the first publication to emanate from a new Canadian research consortium. The Canadian Consortium for Research in Pediatric Surgery (CanCORPS), founded in 2018, aims to improve pediatric surgical care through high quality collaborative research, and includes all major pediatric surgical centers in Canada. The consortium intentionally chose this subject as its very first study, based on the lack of consistent approaches to treatment.

“Findings in earlier publications on the same topic have been inconsistent, with some recommending a conservative approach while others recommending early intervention,” explains Dr. Emil, who serves as the founding Chair of CanCORPS and the Site Director for the RI-MUHC branch of CanCORPS. “With data from so many sites across Canada, this new publication is one of the most in-depth available, and can offer clear recommendations for follow-up and management.”

The next step, Dr. Emil explains, is to design and perform a prospective Canadian multicentre study, to report outcomes using the algorithm proposed in the current paper.

“This study proves that the Canadian pediatric surgery community can collaborate through CanCORPS to produce high-quality research output published in one of the most prestigious surgical journals,” says Dr. Emil. “This is how we can change practice to both benefit patients and optimize resource utilization.”

CanCORPS is supported by the Faculty of Medicine and Health Sciences Mirella and Lino Saputo Foundation Chair in Pediatric Surgical Education and Patient and Family-Centered Care, currently held by Dr. Emil.

Read the publication in Annals of Surgery

June 1st, 2023