title: Surgical treatment of mature cystic teratomas: A comparison of emergent and elective surgeries.
abstract: OBJECTIVE
  To compare patient characteristics, imaging and surgical management of mature cystic teratomas (MCTs) according to surgery type - elective versus emergent.
  
  
  METHODS
  The study included surgeries performed between 1990 and 2016, during which histologically verified ovarian MCT material was obtained. The elective management group included surgeries performed at a pre-set date or incidental finding of MCT as part of a different surgery. Emergent surgeries were considered as such if performed as a result of suspected adnexal torsion.
  
  
  RESULTS
  One hundred ninety two operations in which MCT was confirmed by histology were included: 136 elective, 56 emergent. The majority (88.5%) of study patients were of reproductive age. Patients in the emergent surgery group were significantly younger (27.5 ± 10.2 vs 36 ± 13.8 years, P < 0.001). Sensitivity for dermoid diagnosis was significantly increased among elective surgery patients (65.2% vs. 47.1%, P = 0.02). Laparoscopy was the preferred surgical mode in both study groups. Adnexal torsion was confirmed in 67.8% of emergent surgeries. Conservative surgery, including cystectomy with or without detorsion, was more commonly performed in emergent surgeries (91% vs. 72.7%, P = 0.006). Bilateral salpingo-oophorectomy with or without total abdominal hysterectomy was more commonly performed in elective surgery patients (22% vs. 3.5%, P = 0.001). Patient parity, mass size and white blood cell count were independently associated with adnexal torsion.
  
  
  CONCLUSIONS
  Adnexal torsion is common among symptomatic patients with MCT and is related to mass size, patient age, past parity and white blood cell count. Most patients with MCT are of reproductive age and thus are treated with a minimally invasive approach.
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Hadas
authors.initials: H
authors.lastname: Ganer Herman
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Sagiv
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Hagit
authors.initials: H
authors.lastname: Raphaeli
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ram
authors.initials: R
authors.lastname: Kerner
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Keidar
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Bar
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shimon
authors.initials: S
authors.lastname: Ginath
mesh_terms: D000291:Adnexal Diseases / Q000150:complications / Q000601:surgery; D000328:Adult; D000072700:Conservative Treatment / Q000706:statistics & numerical data; D003884:Dermoid Cyst / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000706:statistics & numerical data; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012489:Salpingostomy / Q000706:statistics & numerical data; D013724:Teratoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: elective; emergent; laparoscopy; mature teratoma; torsion