Malignant ovarian germ cell tumors (MOGCT) are rare in children. Surgery with or without chemotherapy is the primary treatment approach. This study aimed to analyze the impact of primary and delayed surgery on surgical morbidity and outcomes. Second-look surgery after inadequate surgical staging and the various components of surgical staging were also evaluated. Children below 15 years with MOGCT treated between 2006 and 2022 were analyzed. A comparison of patients undergoing primary, delayed, and second-look surgery was performed. 118 patients with a median age of 12 (0.11–15) years were eligible. Forty patients underwent primary, 51 delayed, and 27 second-look surgeries. Overall complications, including tumor rupture, blood loss, and adjacent organ removal, were significantly higher in the primary compared to the delayed surgery group (p = 0.0001). Second-look surgery conceded more blood loss (p = 0.0001), extended duration (p = 0.03), and complications (p = 0.004) than delayed surgery. The compliance with surgical guidelines was 100% for most components, with a positive yield rate of 10–80%. At a median follow-up of 5.2 years, the 5-year event-free survival (EFS) and overall survival (OS) for the entire cohort are 86% and 89%, respectively. The OS and EFS did not differ by the timing of surgery, although the second-look surgery demonstrated relatively inferior outcomes consequential to initial suboptimal surgery. MOGCT shows favorable outcomes. Delayed surgery after chemotherapy in appropriately selected patients minimizes the morbidity of surgery with similar outcomes compared to primary surgery. An optimal initial surgery is essential since second-look surgery produces significant morbidity.

中文翻译：

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手术时机（初次、延迟或复查）对儿童卵巢恶性生殖细胞肿瘤手术发病率和结果的影响

恶性卵巢生殖细胞肿瘤（MOGCT）在儿童中很少见。手术联合或不联合化疗是主要治疗方法。本研究旨在分析初次手术和延迟手术对手术发病率和结果的影响。还评估了手术分期不充分后的二次手术以及手术分期的各个组成部分。对 2006 年至 2022 年间接受 MOGCT 治疗的 15 岁以下儿童进行了分析。对接受初次手术、延迟手术和二次手术的患者进行了比较。 118 名中位年龄为 12 (0.11-15) 岁的患者符合资格。 40 名患者接受了初次手术，51 名患者接受了延迟手术，27 名患者接受了二次手术。与延迟手术组相比，初次手术组的总体并发症（包括肿瘤破裂、失血和邻近器官切除）显着较高（p = 0.0001）。与延迟手术相比，二次手术导致失血量更多 (p = 0.0001)、手术时间延长 (p = 0.03) 和并发症 (p = 0.004)。大多数组件的手术指南符合率为 100%，阳性率为 10-80%。中位随访时间为 5.2 年，整个队列的 5 年无事件生存率 (EFS) 和总生存率 (OS) 分别为 86% 和 89%。 OS 和 EFS 因手术时间的不同而没有差异，尽管二次手术显示出由于初始次优手术而导致的相对较差的结果。 MOGCT 显示出良好的结果。在适当选择的患者中，化疗后延迟手术可以最大限度地降低手术的发病率，并且与初次手术相比具有相似的结果。最佳的初次手术至关重要，因为二次手术会产生显着的发病率。