title: Surgical Outcomes After Debulking Surgery for Intraabdominal Ovarian Growing Teratoma Syndrome: Analysis of 38 Cases.
abstract: BACKGROUND
  The goal, methods, and results of surgery for growing teratoma syndrome (GTS) in men after testicular cancer have been well described. The main surgical challenge relates to the need for vascular or thoracic procedures. But little is known about GTS in women, particularly regarding the optimal management of intraabdominal disease. This study aimed to evaluate the surgical management and outcomes (recurrences and fertility) for a large series of ovarian GTS.
  
  
  METHODS
  This study retrospectively analyzed patients treated for an ovarian immature teratoma (IT) who subsequently experienced abdominal GTS requiring surgery.
  
  
  RESULTS
  Between 1983 and 2014, 196 cases of IT were referred to the authors' institution or treated there, and 38 patients (19 %) subsequently experienced a GTS, including 10 cases of gliomatosis peritonei (containing exclusively pure mature glial tissue). The median age at diagnosis was 26 years (range 8-41 years), and the mean delay between IT and GTS diagnosis was 7 months (range 3-84 months). Surgical resection included peritonectomy (n = 22), diaphragmatic peritoneal resection (n = 14), bowel resection (n = 8), and splenectomy (n = 5). Conservative surgery was possible for 20 patients. Complete cytoreductive surgery was achieved for 25 patients. The mean follow-up period was 73 months (range 3-263 months). At least one recurrence developed for 10 patients (in the form of mature disease in all, and 8 of these patients had an initial complete resection. Five patients had a pregnancy. One patient died of complications from the disease (pulmonary embolism in a patient with bowel obstruction).
  
  
  CONCLUSIONS
  The overall prognosis of abdominal GTS is good. The surgical procedures for GTS are similar to those used in debulking surgery for epithelial cancer. Whenever technically possible, a conservative surgery should be performed because spontaneous fertility is possible. Recurrent GTS is frequent even after complete surgery.
authors.affiliation: Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France.
authors.forename: Enrica
authors.initials: E
authors.lastname: Bentivegna
authors.affiliation: Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France.
authors.forename: Henri
authors.initials: H
authors.lastname: Azaïs
authors.affiliation: Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France.|Unit INSERM 30-10, Villejuif, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Uzan
authors.affiliation: Department of Medical Oncology, Gustave Roussy, Villejuif, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Leary
authors.affiliation: Department of Medical Oncology, Gustave Roussy, Villejuif, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Pautier
authors.affiliation: Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France.
authors.forename: Clementine
authors.initials: C
authors.lastname: Gonthier
authors.affiliation: Department of Pathology, Gustave Roussy, Villejuif, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Genestie
authors.affiliation: Department of Radiology, Gustave Roussy, Villejuif, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Balleyguier
authors.affiliation: Department of Medical Oncology, Gustave Roussy, Villejuif, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lhomme
authors.affiliation: Department of Pathology, Gustave Roussy, Villejuif, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Duvillard
authors.affiliation: Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France. philippe.morice@gustaveroussy.fr.|Unit INSERM 30-10, Villejuif, France. philippe.morice@gustaveroussy.fr.|University Paris Sud, Paris, France. philippe.morice@gustaveroussy.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.affiliation: Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gouy
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D065426:Cytoreduction Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010537:Peritoneum / Q000473:pathology / Q000601:surgery*; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013724:Teratoma / Q000473:pathology / Q000601:surgery*; D055815:Young Adult