Ovarian Tissue Cryopreservation in Young Children: Postoperative Safety and Treatment-Timing Outcomes

Objective: To evaluate age-specific postoperative safety and treatment-timing outcomes after ovarian tissue cryopreservation (OTC), with emphasis on pediatric patients younger than 5 years. Design: Single-center retrospective cohort study Materials and Methods: Patients aged ≤14 years who underwent OTC from 2010–2025 were stratified by age (0–4, 5–9, 10–14 years). Primary outcomes were 30-day postoperative morbidity, including pediatric Clavien–Dindo grade, and postoperative treatment timing. Comparisons used appropriate statistical tests and regression models. Results: Among 161 patients, mean age was 8.37±3.77 years; 28 (17.4%) were aged 0–4 years. Postoperative complications occurred in 14 patients (8.7%) and were predominantly minor pediatric Clavien–Dindo grade I–II events; 2 patients had grade IIIb events, with no severe morbidity or mortality. Complication rates were 14.3%, 8.3%, and 6.9% in the 0–4, 5–9, and 10–14 age groups, respectively, with no significant difference by age group or continuous age (P=0.53 and P=0.11). Children aged 0–4 years had greater postoperative hemoglobin decline than older children (median −0.64 vs 0.12 and −0.03 g/dL; P<0.001), and hematoma risk decreased with age (P=0.04), but no age-related differences in major morbidity, hospitalization length, or treatment disruption. Chemotherapy was postponed in 8 patients (6.1%, mean 5.6±1.4 days), but none were attributable to postoperative complications. Median time to chemotherapy initiation was 7 days and did not differ by age group (P=0.52). Prior chemotherapy and concurrent procedures were not associated with complications, and complications did not prolong hospitalization. Conclusions: OTC was associated with low short-term morbidity and no complication-related delay in oncologic treatment, with this favorable safety profile maintained in children younger than 5 years. These findings support age-inclusive counseling and timely integration of OTC into pediatric oncology care.