Management and outcomes of paediatric non-parasitic splenic cysts: A multi-centre retrospective cohort study and systematic review.

BACKGROUND: Non-parasitic splenic cysts (NPSCs) are rare in children, and optimal management remains controversial. We evaluated management and outcomes of paediatric NPSCs through a retrospective cohort study and systematic review. METHODS: All children with NPSCs at two tertiary paediatric centres over 10 years were retrospectively reviewed. Following PRISMA guidelines, a systematic review was also conducted. Outcomes included cyst resolution or recurrence, complications, splenic preservation rates. RESULTS: 45 patients with NPSCs were analysed in the retrospective cohort: 14 antenatally detected, 18 incidental, 13 symptomatic. Overall, 28/45 (62%) patients were observed, 12/45 (27%) underwent IR procedure/s and 5/45 (11%) surgery. All antenatally detected cysts were observed. Incidentally diagnosed NPSCs requiring further intervention were larger (median 8.2 cm, IQR 7-11; p < 0.001). Symptomatic patients undergoing IR or surgical procedures had no significant difference in median cyst size (13 cm vs 14.2 cm ; p=0.850). IR patients required a median of 3 procedures (IQR 2-4) to reach cyst resolution. Postoperative recurrences were mainly after laparoscopic deroofing (2/3). The systematic review included 31 studies (532 patients). 104 patients (20%) were observed, 53 (10%) underwent IR procedures and 369 (70%) surgery. Symptomatic patients underwent IR or surgical interventions, with subsequent surgery required in 11/53 IR patients (20.7%). Surgical technique varied, with cyst recurrence highest after deroofing (12%) versus 0.7% after partial splenectomy. CONCLUSION: Most asymptomatic NPSCs can be observed. For larger, symptomatic NPSCs, IR interventions are feasible but frequently require repetition. Partial splenectomy appears to provide durable spleen-preserving outcomes.