Better to monitor benign ovarian cysts than to remove them

Cutting is not always the best idea. Not even in medicine. The latest example of this is an international study that supports a more conservative practice for the treatment of benign ovarian cysts: the research proposes a vigilant monitoring of these masses that form in the ovaries instead of surgically removing them. The results of the study, published in The Lancet Oncology, “gives more support to doctors,” say the experts consulted, to help patients in decision-making.

Ovarian cysts are a kind of fluid-filled sacs that form in or around the ovaries. Through an ultrasound, the doctors determine their benign potential – the most common are the functional ones, which are formed with the menstrual cycle and disappear alone – or malignancy. If it is malignant tumors, the approach is to remove them. In the case of benign ones, however, they can be operated on or monitored to control their evolution.

Each health center has its own protocols to treat benign ovarian cysts and the same doctors diverge on the ideal therapeutic approach, says the study conducted by a team of international scientists from institutions such as Imperial College London or the KU Leuven of Leuven. Surgery is used, often at the request of the patients themselves, to avoid the risk of false negatives – which, in reality, the mass is a malignant tumor – or complications in the ovary. However, the surgical approach is not innocuous and, although it is now done in a minimally invasive way (by laparoscopy), it involves risks that must be calibrated and taken into account. The possibility of complications, such as intestinal perforation, in these surgeries to women between 50 and 74 years of age, is between 3% and 15%. “Although these surgical risks are small, if women in this age group underwent surgery in our study, we could speculate that 29 to 123 of them could have suffered serious surgical complications,” said Professor Dirk Timmerman. , principal author of the KU Leuven.

On this scenario, the research has put black on white with a study in which has followed about 2,000 women with these non-cancerous masses in their ovaries. The result is that the so-called “watchful waiting”, where doctors do not remove the cysts, but rather control their size and appearance with regular ultrasounds, is an effective and less risky approach for this type of masses. According to the study, in one in five cases, the cyst disappeared on its own without the need for surgical intervention.

https://elpais.com/elpais/2019/02/14/ciencia/1550170403_288392.html