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Kahn RM, Gordhandas S, Godwin K, Stone RL, Worley MJ, Lu KH, Long Roche KC. Salpingectomy for the Primary Prevention of Ovarian Cancer: A Systematic Review. JAMA Surg 2023; 158:1204-1211. [PMID: 37672283 DOI: 10.1001/jamasurg.2023.4164] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Importance Most ovarian cancers originate in the fimbriated end of the fallopian tube. This has led to the hypothesis that surgical resection of the fallopian tubes at the time of gynecologic and nongynecologic surgical procedures-referred to as an opportunistic salpingectomy-may prevent the development of epithelial ovarian cancer for women at an average risk of developing the disease. Objective To compile a comprehensive, state-of-the-science review examining the current landscape of performing bilateral salpingectomy for ovarian cancer prevention. Evidence Review A systematic review of the literature was performed on March 4, 2022, to identify studies examining salpingectomy for ovarian cancer prevention. This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement. Four databases were selected: PubMed via the National Library of Medicine's PubMed.gov, Embase via Elsevier's Embase.com, Cochrane Central Register of Controlled Trials (CENTRAL) via Wiley's Cochrane Library, and Northern Light Life Sciences Conference Abstracts via Ovid. A total of 20 gray literature sources, including 1 database, 2 registers, 1 repository, 1 index, 1 archive, 1 preprint server, 1 agency, and 12 organizations, were also searched. Findings The initial search produced 1089 results; a total of 158 publications were included in the final review. Salpingectomy has been associated with ovarian cancer risk reduction of approximately 80%. Studies have demonstrated that salpingectomy was safe, cost-effective, and was not associated with an earlier age of menopause onset. With widespread implementation, salpingectomy has the potential to reduce ovarian cancer mortality in the US by an estimated 15%. Both physician and patient awareness regarding the adnexa as the origin for most ovarian cancers, as well as the existence of salpingectomy and its potential benefits in reducing ovarian cancer risk, has increased during the past decade. Raising awareness and developing effective implementation strategies are essential. Conclusions and Relevance The results of this systematic review suggest that bilateral salpingectomy for ovarian cancer prevention was safe and feasible and has the potential to be a cost-effective and cost-saving strategy across the population. Prospective studies to demonstrate long-term survival outcomes and feasibility in nongynecologic surgical procedures are warranted.
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Affiliation(s)
- Ryan M Kahn
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sushmita Gordhandas
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca L Stone
- Department of Obstetrics and Gynecology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Michael J Worley
- Department of Surgery, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Karen H Lu
- Division of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Kara C Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
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Maryns AS, Makar A, Hamerlynck T, De Vree B, Tummers P, Tjalma WAA. Survey: acceptability of opportunistic bilateral salpingectomy in Flanders. Facts Views Vis Obgyn 2021; 13:241-249. [PMID: 34555878 PMCID: PMC8823277 DOI: 10.52054/fvvo.13.3.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The VVOG (Flemish Society of Obstetrics and Gynaecology) published a consensus statement promoting opportunistic bilateral salpingectomy (OBS). Objectives The aim of the study was to obtain insight into the current opinion and general practice of Flemish gynaecologists to counsel and perform OBS. Materials and Methods A questionnaire was distributed to Flemish gynaecologists three months after publication of the consensus statement. Main outcome measures The drawbacks and incentives to counsel and perform OBS were questioned. Results Complete response rate was obtained from 99 gynaecologists (17%) and 37 trainees (19%). The majority of respondents (77%) always counselled for OBS in patients scheduled for hysterectomy without oophorectomy. Eighteen per cent counselled only above a certain age cut off and/or if patient was already menopausal. The most important incentive to counsel in cases of hysterectomy by the abdominal approach and vaginal hysterectomy (VH) was the opportunity to prevent ovarian cancer. The yet-undetermined risk of premature ovarian failure was mentioned as the most important barrier in counselling women for OBS in those undergoing hysterectomy by the abdominal approach. For VH, the respondents saw the risk of complications and increased surgical time as the most important barriers. Sixty-one percent of gynaecologists preferred to perform bilateral salpingectomy as sterilisation method. Conclusions Our study suggests that the concept of OBS is already well known in Flanders. There is a positive attitude towards the routine implementation of OBS, although some barriers and doubts about an age cut-off still exist in practice.
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Ida T, Fujiwara H, Taniguchi Y, Kohyama A. Longitudinal assessment of anti-Müllerian hormone after cesarean section and influence of bilateral salpingectomy on ovarian reserve. Contraception 2021; 103:394-399. [PMID: 33539802 DOI: 10.1016/j.contraception.2021.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to compare longitudinal changes in ovarian reserve markers after cesarean section (CS) with and without bilateral salpingectomy (BS). STUDY DESIGN We prospectively enrolled women >35 weeks' gestation scheduled for CS alone or CS + BS and obtained blood samples for anti-Müllerian hormone prior to surgery and at 3 and 6 months after surgery. At the 3-month visit, we similarly performed transvaginal ultrasound for antral follicle count. RESULTS We enrolled 50 women; 30 underwent CS only and 20 underwent CS + BS. Although anti-Müllerian hormone level increased over 6 months of follow-up in both groups, no clinically important differences in the geometric mean (interquartile range) (ng/mL) were observed at any timepoint (baseline [0.69 {0.36-1.21} {CS only} vs 0.49 {0.32-2.10} {CS + BS}, p = 0.64]; 3 months [1.35 {0.58-3.13} vs 1.45 {1.04-2.25}, p = 0.79]; and 6 months [1.74 {0.93-4.45} vs 2.60 {1.41-5.10}, p =0.27]). Similarly, we detected no difference in antral follicle count. CONCLUSION BS at the time of CS does not have a negative impact on ovarian reserve 6 months after surgery. IMPLICATION While our results provide reassuring data that bilateral salpingectomy for permanent contraception at the time of cesarean section does not impact ovarian reserve, longer adequately powered studies are needed.
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Affiliation(s)
- Tsutomu Ida
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan.
| | - Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yoshimi Taniguchi
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Akira Kohyama
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
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Nelson NC, Ostby SA, Weaver AL, McGree ME, Gebhart JB, Bakkum-Gamez JN. Estimated Blood Loss During Vaginal Hysterectomy and Adnexal Surgery Described With an Intraoperative Pictographic Tool. Female Pelvic Med Reconstr Surg 2018; 24:347-51. [PMID: 28922304 DOI: 10.1097/SPV.0000000000000470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We describe a novel way to calculate estimated blood loss (EBL) using an intraoperative pictographic tool in gynecologic surgery. METHODS A pictographic tool to estimate sponge saturation was developed to calculate EBL during surgery. A prospective cohort of women 18 years or older undergoing benign vaginal hysterectomy with planned adnexal surgery at Mayo Clinic were consented for use of the pictographic tool. Demographic, preoperative, intraoperative, and postoperative data were abstracted. Estimated blood loss was compared among surgeons, anesthesia providers, and the pictographic tool and then correlated with change in hemoglobin. RESULTS Eighty-one patients met inclusion with mean age of 45.3 ± 8.7 years. Successful vaginal hysterectomy was achieved in all patients with successful completion of planned adnexectomy in 69 (85.2%). Mean EBL among surgeons, anesthesia providers, and pictographic estimates, respectively, was as follows: 199.4 ± 81.9 mL, 195.5 ± 152.2 mL, and 288.5 ± 186.6 mL, with concordance correlation coefficients for surgeons and anesthesia providers versus pictographic tool of 0.40 (95% confidence interval, 0.29-0.51) and 0.68 (95% confidence interval, 0.57-0.79), respectively. The mean postoperative change in hemoglobin was -1.8 g/dL; there were no postoperative transfusions. Change in hemoglobin was more correlated with blood loss estimates from surgeons (r = -0.31, P = 0.008) and anesthesia providers (r = -0.37, P = 0.003) than the pictographic tool (r = -0.19, P = 0.11). CONCLUSIONS Use of a pictographic tool to objectively estimate blood loss demonstrated significant overestimations compared with both anesthesia providers' and surgeons' estimates because the pictographic tool was less correlated with postoperative change in hemoglobin than anesthesia provider and surgeon estimates.
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Kim AJ, Barberio A, Berens P, Chen HY, Gants S, Swilinski L, Acholonu U, Chang-Jackson SC. The Trend, Feasibility, and Safety of Salpingectomy as a form of Permanent Sterilization. J Minim Invasive Gynecol 2019; 26:1363-1368. [PMID: 30771489 DOI: 10.1016/j.jmig.2019.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To assess the change in the rate of laparoscopic salpingectomy for sterilization after the release of the November 2013 Society of Gynecologic Oncology Clinical Practice Statement and the January 2015 American College of Obstetricians and Gynecologists Committee Opinion: Salpingectomy for Ovarian Cancer Prevention. We hypothesized there would be an increase in salpingectomy as a percentage of total laparoscopic sterilizations performed without an increase in complications when compared with conventional bilateral tubal ligation (BTL). DESIGN A retrospective cohort study. SETTING Four university-affiliated hospitals in Houston, TX, and New York, NY. PATIENTS All women 21 years or older who underwent interval laparoscopic permanent sterilization between April 2013 and September 2016. INTERVENTIONS Sterilization by bilateral salpingectomy or conventional tubal ligation. MEASUREMENTS AND MAIN RESULTS There were 454 sterilization procedures identified; 60% were BTLs, whereas 40% were salpingectomies. The rate of use of salpingectomy significantly increased from 5% to 9% in 2013 to 2014 to 78% by 2016. There was no significant difference in intraoperative or postoperative complications or estimated blood loss. The mean procedure time was 54 minutes for salpingectomy compared with 45 minutes for BTL (p <.0001). Salpingectomy was more likely to require 3 ports compared with 2 ports for BTL (p <.0001). CONCLUSIONS The Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists' support of salpingectomy for ovarian cancer prevention increased its use for sterilization. Based on this study, laparoscopic bilateral salpingectomy is a safe method of sterilization without an increase in perioperative risk compared with conventional tubal ligation. Physicians should incorporate these findings and implications when counseling patients regarding contraception and permanent sterilization.
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Affiliation(s)
- Annie J Kim
- Department of Obstetrics and Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas (Drs. Kim, Berens, Chen, Gants, Swilinski, and Chang-Jackson).
| | - Andrea Barberio
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital/Weill Cornell, New York, New York (Drs. Barberio and Acholonu)
| | - Pamela Berens
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital/Weill Cornell, New York, New York (Drs. Barberio and Acholonu)
| | - Han-Yang Chen
- Department of Obstetrics and Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas (Drs. Kim, Berens, Chen, Gants, Swilinski, and Chang-Jackson)
| | - Shavonia Gants
- Department of Obstetrics and Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas (Drs. Kim, Berens, Chen, Gants, Swilinski, and Chang-Jackson)
| | - Lisa Swilinski
- Department of Obstetrics and Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas (Drs. Kim, Berens, Chen, Gants, Swilinski, and Chang-Jackson)
| | - Uchenna Acholonu
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital/Weill Cornell, New York, New York (Drs. Barberio and Acholonu)
| | - Shao-Chun Chang-Jackson
- Department of Obstetrics and Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas (Drs. Kim, Berens, Chen, Gants, Swilinski, and Chang-Jackson)
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Hanley GE, Rozenberg NMK, McAlpine JN. Risk-reducing Surgery in Women at Low Lifetime Risk of Developing Ovarian Carcinoma: Opportunistic Salpingectomy. Clin Obstet Gynecol 2017; 60:758-70. [PMID: 28957952 DOI: 10.1097/GRF.0000000000000315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lack of success in ovarian cancer control through screening or advances in treatment in the general population has prompted exploration in new avenues of prevention. "Opportunistic" salpingectomy describes a surgical procedure or risk-reducing intent in women at low-risk/general population risk for developing ovarian cancer who are undergoing pelvic/abdominal surgery for other indications. This chapter reviews the uptake, safety, and anticipated impact of this prevention initiative.
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Sussman RD, Han CJ, Marchalik D, Carvahlo FL, Davis MF, Richter LA, Wethington SL, Stamatakis L. To oophorectomy or not to oophorectomy: Practice patterns among urologists treating bladder cancer. Urol Oncol 2018; 36:90.e1-90.e7. [DOI: 10.1016/j.urolonc.2017.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/24/2017] [Accepted: 11/27/2017] [Indexed: 02/09/2023]
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Venturella R, Rocca M, Lico D, Trapasso S, Di Cello A, Gizzo S, Zullo F, Morelli M. Prophylactic bilateral salpingectomy for the prevention of ovarian cancers: What is happening in Italy? Eur J Cancer Prev 2016; 25:410-5. [PMID: 26275007 DOI: 10.1097/CEJ.0000000000000191] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In 2011, the Society of Gynecologic Oncology of Canada encouraged physicians to discuss with their patients the risks and benefits of prophylactic bilateral salpingectomy (PBS) at the time of hysterectomy or tubal ligation for prevention of ovarian cancers (OCs). The aim of this study was to examine obstetrician-gynaecologists' knowledge, opinions and practice patterns relating to opportunistic salpingectomy in the general population. An anonymous electronic survey was sent to residents, academic and hospital staff in Italian OBGYN departments. The survey included questions on demographics, knowledge and attitudes in terms of the implementation of PBS in women at average population risk of OC. At least 80% of the 479 respondents reported performing PBS during hysterectomy for benign indications, chiefly with the intent of OC risk reduction but also to decrease the risk of reoperation and subsequent tubal pathologies. Among the 86 colleagues who do not routinely perform PBS, more than 50% stated that they have doubts regarding the benefits associated with the procedure. Most of the respondents declared that they were familiar with the literature on the topic and were aware of the data reporting the safety of the procedure, and only 21 (4.53%) had never heard of PBS. Over 40% of the respondents worked in hospitals in southern Italy. PBS as a prophylactic measure to reduce the incidence of OC is a well-known strategy among the Italian OBGYNs interviewed. Given the unequal distribution of respondents, however, wider educational initiatives should be undertaken, at least in Italy, to increase the implementation of salpingectomy among OBGYNs.
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Thompson C, McCormick C, Kamran W, O'Riain C, Norris L, Gallagher D, Gleeson N. Risk reduction surgery (RRS) for tubo-ovarian cancer in an Irish gynaecological practice: an analysis of indications and outcomes. Ir J Med Sci 2018; 187:789-794. [PMID: 29299762 DOI: 10.1007/s11845-017-1717-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 11/13/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND High-grade serous carcinoma (HGSC) is the most common tubo-ovarian cancer. The fallopian tube harbours the precursor lesion: serous tubal intraepithelial carcinoma (STIC). Bilateral salpingo-oophorectomy is an effective risk-reducing surgical (RRS) strategy for breast cancer susceptibility gene mutation carriers (BRCAm). The value of RRS in those without defined genetic risk is unknown but these women represent a substantial cohort in prophylactic surgical practice. METHODS This is a retrospective review of RRS at an Irish university teaching hospital. RESULTS One hundred and thirty women underwent RRS; group 1 = 46 BRCAm; group 2 = 19 BRCAm negative/65 genetic status unknown. Group 1 had one occult HGSC. Group 2 had no STIC or cancers and were older and more likely to have hysterectomy and benign pathology. Other pathologies included serous tubal intraepithelial lesions (STIL) (2), p53 signatures (2), endometriosis (6), fibroids/adenomyosis (4) and atypical endometrial hyperplasia (1). CONCLUSION More than 60% of women undergoing RRS were BRCAm negative or untested. Counselling of high-risk women without defined germline mutations remains a challenge for gynaecologists because the likelihood of removing STIC lesions or occult invasive cancer is low. Removal of coincidental pathology may give added value to RRS in these women.
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Affiliation(s)
- Claire Thompson
- Gynaecological Oncology Department, St James's Hospital, Dublin, Ireland.
| | - Ciara McCormick
- Gynaecological Oncology Department, St James's Hospital, Dublin, Ireland
| | - Waseem Kamran
- Gynaecological Oncology Department, St James's Hospital, Dublin, Ireland
| | - Ciaran O'Riain
- Histopathology Department, St James's Hospital, Dublin, Ireland
| | - Lucy Norris
- Obstetrics and Gynaecology Department, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - David Gallagher
- Medical Oncology Department, St James's Hospital, Dublin, Ireland
| | - Noreen Gleeson
- Gynaecological Oncology Department, St James's Hospital, Dublin, Ireland
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Piszczek C, Ma J, Gould CH, Tseng P. Cancer Risk-Reducing Opportunities in Gynecologic Surgery. J Minim Invasive Gynecol 2017; 25:1179-1193. [PMID: 29097232 DOI: 10.1016/j.jmig.2017.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 12/16/2022]
Abstract
This review article discusses cancer risk-reducing opportunities in gynecologic surgery. We cover strategies to reduce ovarian and uterine cancer risk by presenting general practice guidelines and expanding on the literature behind clinical decision points. We address populations of women at increased hereditary risk and those at population risk. We specifically discuss risk-reducing salpingo-oophorectomy, prophylactic salpingectomy with delayed oophorectomy, concomitant hysterectomy, opportunistic salpingectomy, bilateral tubal ligation, and hysterectomy. For clinical scenarios in which data are limited or conflicting, we detail the studies on which clinicians' decisions hinge to allow the reader to weigh the available evidence.
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Affiliation(s)
- Carolyn Piszczek
- Division of Women's Services, Legacy Health System, Portland, Oregon.
| | - Jun Ma
- Divisions of Gynecologic Oncology, Legacy Medical Group, Portland, Oregon
| | - Claire H Gould
- Advanced Gynecology, Legacy Medical Group, Portland, Oregon
| | - Paul Tseng
- Divisions of Gynecologic Oncology, Legacy Medical Group, Portland, Oregon
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Duncan JR, Schenone MH, Mari G. Technique for bilateral salpingectomy at the time of Cesarean delivery: a case series. Contraception 2017; 95:509-11. [DOI: 10.1016/j.contraception.2017.02.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/17/2017] [Accepted: 02/27/2017] [Indexed: 11/22/2022]
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Scheib SA. A Laparoendoscopic Single-site Surgical Approach to Laparoscopic Salpingectomy. J Minim Invasive Gynecol 2017; 25:326-327. [PMID: 28342812 DOI: 10.1016/j.jmig.2017.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/06/2017] [Accepted: 03/15/2017] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To demonstrate a laparoendoscopic single-site (LESS) surgical approach to salpingectomy. DESIGN A technical video showing step-by-step a LESS surgical approach to salpingectomy (Canadian Task Force classification level III). Institutional review board approval was not required for this study. SETTING Of all gynecologic cancer types, ovarian cancer has the highest mortality rate and is the fifth leading cause of cancer deaths among women [1,2]. The leading theory of epithelial ovarian carcinogenesis indicates that serous, endometrioid, and clear cell ovarian carcinomas originated from the fallopian tube and endometrium and not directly from the ovary itself [1-10]. This has led to the use of prophylactic salpingectomy as a theoretical form of ovarian cancer risk reduction at the time of hysterectomy or as a means of tubal sterilization. Prophylactic salpingectomy does not appear to increase the risk of complications and appears to be safe [2]. Ovarian function does not seem to be compromised by salpingectomy based on serum markers or response rates with in vitro fertilization [11-16]. A LESS approach may reduce the morbidity associated with the placement of multiple ports and can improve cosmetic outcomes. Prophylactic LESS bilateral salpingo-oohorectomy was shown to be feasible and safe for high-risk patients for ovarian cancer [17]. INTERVENTIONS Laparoscopic salpingectomy at the time of hysterectomy or as a means of tubal sterilization using the LESS technique. CONCLUSION This is a simple and reproducible technique for preventing major complications associated with LESS salpingectomy. This approach permits easier specimen retrieval because of the large solitary incision that is made. There is a significant improvement in cosmetic satisfaction when compared with a traditional laparoscopic approach in the setting of prophylactic risk reduction surgery [18].
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Affiliation(s)
- Stacey A Scheib
- Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins University Hospital, Baltimore, Maryland.
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13
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Ciebiera M, Baran A, Słabuszewska-Jóźwiak A, Jakiel G. Case report of ovarian torsion mimicking ovarian cancer as an uncommon late complication of laparoscopic supracervical hysterectomy. Prz Menopauzalny 2016; 15:223-6. [PMID: 28250728 DOI: 10.5114/pm.2016.65669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 12/29/2016] [Indexed: 12/05/2022]
Abstract
Laparoscopic supracervical hysterectomy (LSH) is an example of a partial hysterectomy, performed due to benign gynaecological complaints. Better endoscopic instruments and operational techniques have led to a great reduction in the number of abdominal hysterectomies. It is believed that LSH is a safe and minimally invasive hysterectomy technique. The Cochrane Database meta-analysis proves the benefits of minimally invasive surgery compared with abdominal gynaecological surgery, including decreased pain, surgical-site infections and hospital stay, quicker return to activity, and fewer postoperative adhesions. According to recent publications, the overall complication rate of all hysterectomy methods is about 1-4.5%. Adnexal torsion is a correlated complication. About 3-5% of patients undergoing emergency surgery due to pelvic pain are diagnosed with this condition. It may be the cause of acute abdomen and correlated symptoms such as vomiting, nausea, or severe pain. To the best of our knowledge a case of asymptomatic, delayed ovarian torsion mimicking ovarian tumour has not been reported so far. In the presented case, torsion successfully imitated neoplastic process as both ROMA score and IOTA ‘simple rules’ indicated a malignancy with high degree of probability. This case demonstrates that, if ovarian tumour is detected in the postoperative period, a torsion of ovarian pedicle should be taken into consideration as it may mimic malignant neoplasm.
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Jones NL, Schulkin J, Urban RR, Wright JD, Burke WM, Hou JY, McElwain CA, Tergas AI. Physicians' Perspectives and Practice Patterns Toward Opportunistic Salpingectomy in High- and Low-Risk Women. Cancer Invest 2016; 35:51-61. [PMID: 28029807 DOI: 10.1080/07357907.2016.1242597] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Opportunistic bilateral salpingectomy (OBS) has been proposed as an ovarian cancer risk-reducing strategy. METHODS A survey was emailed to 300 members of the American College of Obstetricians and Gynecologists. RESULTS 125 (42%) surveys were returned: 60% female, 88% generalists, 67% private practice. Only 36% correctly identified the lifetime risk of ovarian cancer, only 23% understood the risk-reducing benefit of bilateral salpingo-oophorectomy. 75% perform salpingectomy during hysterectomy, 26-53% use for sterilization depending on approach. Concerns were increased operative time and complications. For BRCA mutations, 64% recommend BSO, 12% recommend a two-step risk-reducing strategy, and 14% refer to gynecologic oncology. CONCLUSIONS We identified broad support and factors limiting willingness to perform OBS.
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Affiliation(s)
- Nathaniel L Jones
- a Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , New York , USA.,b New York Presbyterian Hospital , New York , New York , USA
| | - Jay Schulkin
- c Department of Obstetrics and Gynecology , University of Washington , Seattle , Washington , USA.,d Research Department , American College of Obstetricians and Gynecologists , Washington, DC , USA
| | - Renata R Urban
- c Department of Obstetrics and Gynecology , University of Washington , Seattle , Washington , USA
| | - Jason D Wright
- a Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , New York , USA.,b New York Presbyterian Hospital , New York , New York , USA.,e Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - William M Burke
- a Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , New York , USA.,b New York Presbyterian Hospital , New York , New York , USA.,e Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - June Y Hou
- a Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , New York , USA.,b New York Presbyterian Hospital , New York , New York , USA.,e Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Cora A McElwain
- d Research Department , American College of Obstetricians and Gynecologists , Washington, DC , USA
| | - Ana I Tergas
- a Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , New York , USA.,b New York Presbyterian Hospital , New York , New York , USA.,e Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York , New York , USA.,f Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , New York , USA
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Potz FL, Tomasch G, Polterauer S, Laky R, Marth C, Tamussino K. Incidental (Prophylactic) Salpingectomy at Benign Gynecologic Surgery and Cesarean Section: a Survey of Practice in Austria. Geburtshilfe Frauenheilkd 2016; 76:1325-1329. [PMID: 28017973 DOI: 10.1055/s-0042-116493] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction: Most serous ovarian cancers are now thought to originate in the fallopian tubes. This has raised the issue of performing incidental salpingectomy (also called elective, opportunistic, prophylactic or risk-reducing salpingectomy) at the time of benign gynecologic surgery or cesarean section. We conducted an online survey to ascertain the policies regarding incidental salpingectomy in Austria in late 2014. Material and Methods: All 75 departments of obstetrics and gynecology in public hospitals in Austria were surveyed for their policies regarding incidental salpingectomy at benign gynecologic surgery or cesarean section. Results: Sixty-six of 75 surveyed departments completed the questionnaire, resulting in a response rate of 88 %. Overall, 46 of 66 (70 %) units reported offering or recommending incidental salpingectomy at benign gynecologic surgery, 12 units (18 %) did not, and eight units (12 %) did not have a consistent policy. Salpingectomy was the preferred method for surgical sterilization, including sterilization at the time of cesarean section (71 % and 64 % of units, respectively). Conclusions: Incidental (elective, opportunistic, prophylactic, risk-reducing) salpingectomy is now widely offered at benign gynecologic surgery and cesarean section in Austria. Evidence for the role of the fallopian tubes in the origin of serous pelvic cancer has led to changes in clinical practice.
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Affiliation(s)
- F L Potz
- Division of Gynecology, Department of Obstetrics & Gynecology, Medical University of Graz, Graz, Austria
| | - G Tomasch
- Division of Gynecology, Department of Obstetrics & Gynecology, Medical University of Graz, Graz, Austria
| | - S Polterauer
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics & Gynecology, Medical University of Vienna, Vienna, Austria
| | - R Laky
- Division of Gynecology, Department of Obstetrics & Gynecology, Medical University of Graz, Graz, Austria
| | - C Marth
- Department of Obstetrics & Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - K Tamussino
- Division of Gynecology, Department of Obstetrics & Gynecology, Medical University of Graz, Graz, Austria
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16
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Chene G, de Rochambeau B, Le Bail-Carval K, Beaufils E, Chabert P, Mellier G, Lamblin G. [Current surgical practice of prophylactic and opportunistic salpingectomy in France]. ACTA ACUST UNITED AC 2016; 44:377-84. [PMID: 27363615 DOI: 10.1016/j.gyobfe.2016.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/09/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Since the recent evidence of a tubal origin of most ovarian cancers, opportunistic salpingectomy could be discussed as a prophylactic strategy in the general population and with hereditary predisposition. We aimed to survey French gynecological surgeons about their current surgical practice of prophylactic salpingectomy. METHODS An anonymous online survey was sent to French obstetrician-gynaecologists and gynecological surgeons. There were 13 questions about their current clinical practice and techniques of salpingectomy during a benign hysterectomy or as a tubal sterilization method, salpingectomy versus salpingo-oophorectomy in the population with genetic risk, salpingectomy in relationship with endometriosis and questions including histopathological considerations. RESULTS Among the 569 respondents, opportunistic salpingectomy was always performed between 42.48% and 43.44% during laparoscopic, laparoscopic-assisted vaginal or laparotomic hysterectomy and only 12.26% in case of vaginal route. In the genetic population, salpingo-oophorectomy was mainly performed. Tubal sterilization was often practiced by the hysteroscopic route. More than 90% of respondents didn't perform salpingectomy in case of endometriosis. There was not any specific tubal histopathological protocol in 71.54% of cases. CONCLUSIONS Salpingectomy may be a preventing strategy in the low- and high-risk population. The survey's responses show that salpingectomy seems to be a current practice during benign hysterectomy for more than 40% doctors. However, there is not any change with no more salpingectomy in the population with genetic risk, or in case of endometriosis or tubal sterilization.
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Affiliation(s)
- G Chene
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France; EMR 3738, université Claude-Bernard Lyon 1, 69000 Lyon, France.
| | - B de Rochambeau
- Département de gynécologie-obstétrique, hôpital privé Marne-Chantereine, 77177 Brou-sur-Chantereine, France
| | - K Le Bail-Carval
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France
| | - E Beaufils
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France
| | - P Chabert
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France
| | - G Mellier
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France
| | - G Lamblin
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France
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17
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Karakasis K, Burnier JV, Bowering V, Oza AM, Lheureux S. Ovarian Cancer and BRCA1/2 Testing: Opportunities to Improve Clinical Care and Disease Prevention. Front Oncol 2016; 6:119. [PMID: 27242959 PMCID: PMC4862980 DOI: 10.3389/fonc.2016.00119] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/28/2016] [Indexed: 01/07/2023] Open
Abstract
Without prevention or screening options available, ovarian cancer is the most lethal malignancy of the female reproductive tract. High-grade serous ovarian cancer (HGSOC) is the most common histologic subtype, and the role of germline BRCA1/2 mutation in predisposition and prognosis is established. Given the targeted treatment opportunities with PARP inhibitors, a predictive role for BRCA1/2 mutation has emerged. Despite recommendations to provide BRCA1/2 testing to all women with histologically confirmed HGSOC, uniform implementation remains challenging. The opportunity to review and revise genetic screening and testing practices will identify opportunities, where universal adoption of BRCA1/2 mutation testing will impact and improve treatment of women with ovarian cancer. Improving education and awareness of genetic testing for women with cancer, as well as the broader general community, will help focus much-needed attention on opportunities to advance prevention and screening programs in ovarian cancer. This is imperative not only for women with cancer and those at risk of developing cancer but also for their first-degree relatives. In addition, BRCA1/2 testing may have direct implications for patients with other types of cancers, many of which are now being found to have BRCA1/2 involvement.
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Affiliation(s)
- Katherine Karakasis
- Drug Development Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto , Toronto, ON , Canada
| | - Julia V Burnier
- Drug Development Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto , Toronto, ON , Canada
| | - Valerie Bowering
- Drug Development Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto , Toronto, ON , Canada
| | - Amit M Oza
- Drug Development Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto , Toronto, ON , Canada
| | - Stephanie Lheureux
- Drug Development Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto , Toronto, ON , Canada
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18
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Affiliation(s)
- Jessica N McAlpine
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
| | - Alicia A Tone
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre, Toronto ON
| | - Gillian E Hanley
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
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19
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McAlpine JN, Tone AA, Hanley GE. La salpingectomie opportuniste : Nous choisissons d'agir, pas d'attendre. Journal of Obstetrics and Gynaecology Canada 2016; 38:428-31. [DOI: 10.1016/j.jogc.2016.04.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Fujiwara K, McAlpine JN, Lheureux S, Matsumura N, Oza AM. Paradigm Shift in the Management Strategy for Epithelial Ovarian Cancer. Am Soc Clin Oncol Educ Book 2016; 35:e247-e257. [PMID: 27249730 DOI: 10.1200/edbk_158675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The hypothesis on the pathogenesis of epithelial ovarian cancer continues to evolve. Although epithelial ovarian cancer had been assumed to arise from the coelomic epithelium of the ovarian surface, it is now becoming clearer that the majority of serous carcinomas arise from epithelium of the distal fallopian tube, whereas clear cell and endometrioid cancers arise from endometriosis. Molecular and genomic characteristics of epithelial ovarian cancer have been extensively investigated. Our understanding of pathogenesis of the various histologic types of ovarian cancer have begun to inform changes to the strategies for management of epithelial ovarian cancer, which represent a paradigm shift not only for treatment but also for prevention, which previously had not been considered achievable. In this article, we will discuss novel attempts at the prevention of high-grade serous ovarian cancer and treatment strategies for two distinct entities in epithelial ovarian cancer: low-grade serous and clear cell ovarian carcinomas, which are relatively rare and resistant to conventional chemotherapy.
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Affiliation(s)
- Keiichi Fujiwara
- From the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan; Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, Canada; Division of Medical Oncology and Hematology, Bras Family Drug Development Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Jessica N McAlpine
- From the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan; Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, Canada; Division of Medical Oncology and Hematology, Bras Family Drug Development Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Stephanie Lheureux
- From the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan; Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, Canada; Division of Medical Oncology and Hematology, Bras Family Drug Development Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Noriomi Matsumura
- From the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan; Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, Canada; Division of Medical Oncology and Hematology, Bras Family Drug Development Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Amit M Oza
- From the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan; Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, Canada; Division of Medical Oncology and Hematology, Bras Family Drug Development Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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21
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Abstract
Hereditary breast and ovarian cancer syndrome carries significant mortality for young women if effective preventive and screening measures are not taken. Preventive salpingo-oophorectomy is currently the only method known to reduce the risk of ovarian cancer-related death. Histopathological analyses of these surgical specimens indicate that a high proportion of ovarian cancers in women at high risk and in the general population arise from the fallopian tube. This paradigm shift concerning the cell of origin for the most common subtype of ovarian cancer, high-grade serous carcinoma, has sparked a major effort within the research community to develop new and robust model systems to study the fallopian tube epithelium as the cell of origin of "ovarian" cancer. In this review, evidence supporting the fallopian tube as the origin of ovarian cancer is presented as are novel experimental model systems for studying the fallopian tube epithelium in high-risk women as well as in the general population. This review also addresses the clinical implications of the newly proposed cell of origin, the clinical questions that arise, and novel strategies for ovarian cancer prevention.
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Affiliation(s)
- Ruth Perets
- Division of Oncology, Clinical Research Institute at Rambam, Rambam Health Care Campus, Haifa, Israel.
| | - Ronny Drapkin
- Department of Obstetrics and Gynecology, Ovarian Cancer Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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22
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Selmes G, Ferron G, Filleron T, Querleu D, Mery E. Lésions épithéliales précoces dans les annexectomies prophylactiques chez des patientes à haut risque de cancer de l’ovaire : à propos d’une série de 93 cas. ACTA ACUST UNITED AC 2015; 43:659-64. [DOI: 10.1016/j.gyobfe.2015.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/08/2015] [Indexed: 12/31/2022]
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23
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Hanley GE, McAlpine JN, Kwon JS, Mitchell G. Opportunistic salpingectomy for ovarian cancer prevention. Gynecol Oncol Res Pract 2015; 2:5. [PMID: 27231565 PMCID: PMC4881168 DOI: 10.1186/s40661-015-0014-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/09/2015] [Indexed: 04/29/2023]
Abstract
Recently accumulated evidence has strongly indicated that the fallopian tube is the site of origin for the majority of high-grade serous ovarian or peritoneal carcinomas. As a result, recommendations have been made to change surgical practice in women at general population risk for ovarian cancer and perform bilateral salpingectomy at the time of hysterectomy without oophorectomy and in lieu of tubal ligation, a practice that has been termed opportunistic salpingectomy (OS). Despite suggestions that bilateral salpingectomy may be used as an interim procedure in women with BRCA1/2 mutations, enabling them to delay oophorectomy, there is insufficient evidence to support this practice as a safe alternative and risk-reducing bilateral salpingo-oophorectomy remains the recommended standard of care for high-risk women. While evidence on uptake of OS is sparse, it points toward increasing practice of OS during hysterectomy. The practice of OS for sterilization purposes, although expanding, appears to be less common. Operative and perioperative complications as measured by administered blood transfusions, hospital length of stay and readmissions were not increased with the addition of OS either at time of hysterectomy or for sterilization. Additional operating room time was 16 and 10 min for OS with hysterectomy and OS for sterilization, respectively. Short-term studies of the consequences of OS on ovarian function indicate no difference between women undergoing hysterectomy alone and hysterectomy with OS, but no long-term data exist. There is emerging evidence of effectiveness of excisional sterilization on reducing ovarian cancer rates from Rochester (OR = 0.36 95 % CI 0.13, 1.02), and bilateral salpingectomy from Denmark (OR = 0.58 95 % CI 0.36, 0.95) and Sweden (HR = 0.35, 95 % CI 0.17, 0.73), but these studies suffer from limitations, including that they were performed for pathological rather than prophylactic purposes. Initial cost-effectiveness modeling indicates that OS is cost-effective over a wide range of costs and risk estimates. While preliminary safety, efficacy, and cost-effectiveness data are promising, further research is needed (particularly long-term data on ovarian function) to firmly establish the safety of the procedure. The marginal benefit of OS compared with tubal ligation or hysterectomy alone needs to be established through large prospective studies of OS done for prophylaxis.
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Affiliation(s)
- Gillian E Hanley
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, BC Canada
| | - Jessica N McAlpine
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, BC Canada
| | - Janice S Kwon
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, BC Canada
| | - Gillian Mitchell
- Hereditary Cancer Program, BC Cancer Agency, Vancouver, BC Canada ; Department of Medicine, University of British Columbia, Vancouver, BC Canada
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24
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Ganer Herman H, Shalev A, Ginath S, Kerner R, Keidar R, Bar J, Sagiv R. Clinical characteristics and the risk for malignancy in postmenopausal women with adnexal torsion. Maturitas 2015; 81:57-61. [DOI: 10.1016/j.maturitas.2015.02.261] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 02/23/2015] [Accepted: 02/25/2015] [Indexed: 11/24/2022]
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25
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Abstract
Ovarian cancer has the highest mortality rate out of all types of gynecologic cancer and is the fifth leading cause of cancer deaths among women. Current attempts at screening for ovarian cancer have been unsuccessful and are associated with false-positive test results that lead to unnecessary surgery and surgical complications. Prophylactic salpingectomy may offer clinicians the opportunity to prevent ovarian cancer in their patients. Randomized controlled trials are needed to support the validity of this approach to reduce the incidence of ovarian cancer. The approach to hysterectomy or sterilization should not be influenced by the theoretical benefit of salpingectomy. Surgeons should continue to observe and practice minimally invasive techniques.
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26
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Han-Suyin K, O'Brien D, Mooney EE, Downey P. Low rates of fimbrial excision at tubal ligation: room for improvement? Eur J Obstet Gynecol Reprod Biol 2014; 185:182-3. [PMID: 25547523 DOI: 10.1016/j.ejogrb.2014.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 11/25/2014] [Accepted: 12/05/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Kathleen Han-Suyin
- MRCPI, Department of Pathology, National Maternity Hospital, Dublin 2, Ireland
| | - Donal O'Brien
- MRCOG, Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin 2, Ireland
| | - Eoghan E Mooney
- FRCPath, Department of Pathology, National Maternity Hospital, Dublin 2, Ireland
| | - Paul Downey
- FRCPath, Department of Pathology, National Maternity Hospital, Dublin 2, Ireland.
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27
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Leblanc E, Vennin P, Narducci F, Merlot B, Bresson L, Farré I, Salzet M, Bertrand O, Maillez A, Adenis C. Chirurgie annexielle prophylactique des femmes à risque héréditaire : vers de nouvelles pistes ? ONCOLOGIE 2014; 16:438-444. [DOI: 10.1007/s10269-014-2451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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29
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Yang-Hartwich Y, Gurrea-Soteras M, Sumi N, Joo WD, Holmberg JC, Craveiro V, Alvero AB, Mor G. Ovulation and extra-ovarian origin of ovarian cancer. Sci Rep 2014; 4:6116. [PMID: 25135607 PMCID: PMC4137344 DOI: 10.1038/srep06116] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/25/2014] [Indexed: 12/16/2022] Open
Abstract
The mortality rate of ovarian cancer remains high due to late diagnosis and recurrence. A fundamental step toward improving detection and treatment of this lethal disease is to understand its origin. A growing number of studies have revealed that ovarian cancer can develop from multiple extra-ovarian origins, including fallopian tube, gastrointestinal tract, cervix and endometriosis. However, the mechanism leading to their ovarian localization is not understood. We utilized in vitro, ex vivo, and in vivo models to recapitulate the process of extra-ovarian malignant cells migrating to the ovaries and forming tumors. We provided experimental evidence to support that ovulation, by disrupting the ovarian surface epithelium and releasing chemokines/cytokines, promotes the migration and adhesion of malignant cells to the ovary. We identified the granulosa cell-secreted SDF-1 as a main chemoattractant that recruits malignant cells towards the ovary. Our findings revealed a potential molecular mechanism of how the extra-ovarian cells can be attracted by the ovary, migrate to and form tumors in the ovary. Our data also supports the association between increased ovulation and the risk of ovarian cancer. Understanding this association will lead us to the development of more specific markers for early detection and better prevention strategies.
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Affiliation(s)
- Yang Yang-Hartwich
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Marta Gurrea-Soteras
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Natalia Sumi
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Won Duk Joo
- CHA Bundang Medical Center, CHA University, South Korea
| | - Jennie C Holmberg
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Vinicius Craveiro
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Ayesha B Alvero
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Gil Mor
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520, USA
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30
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Schenberg T, Mitchell G. Prophylactic bilateral salpingectomy as a prevention strategy in women at high-risk of ovarian cancer: a mini-review. Front Oncol 2014; 4:21. [PMID: 24575389 PMCID: PMC3918654 DOI: 10.3389/fonc.2014.00021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/26/2014] [Indexed: 12/23/2022] Open
Abstract
Risk-reducing bilateral salpingo-oophorectomy is a proven strategy to reduce the risk of serous ovarian cancer associated with germline BRCA mutations. It is most effective when performed before natural menopause, but it will render a woman prematurely menopausal. The tubal hypothesis of serous ovarian cancer brings with it the possibility of the alternative surgical approach in younger women comprising of risk-reducing bilateral salpingectomy while conserving their ovaries until nearer the age of natural menopause, when a delayed bilateral oophorectomy can be performed. This article will review the evidence behind the tubal hypothesis of serous ovarian cancer and explore the opportunities for translating this into clinical cancer prevention practice.
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Affiliation(s)
- Tess Schenberg
- The Western Health Public Hospital, Melbourne, VIC, Australia
| | - Gillian Mitchell
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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31
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Menon U, Griffin M, Gentry-Maharaj A. Ovarian cancer screening--current status, future directions. Gynecol Oncol 2013; 132:490-5. [PMID: 24316306 PMCID: PMC3991859 DOI: 10.1016/j.ygyno.2013.11.030] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/22/2013] [Accepted: 11/25/2013] [Indexed: 01/06/2023]
Abstract
Evidence of a mortality benefit continues to elude ovarian cancer (OC) screening. Data from the US Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial which used a screening strategy incorporating CA125 cut-off and transvaginal ultrasound has not shown mortality benefit. The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) is using the Risk of Ovarian Cancer (ROC) time series algorithm to interpret CA125, which has shown an encouraging sensitivity and specificity however the mortality data will only be available in 2015. The article explores the impact of growing insights into disease aetiology and evolution and biomarker discovery on future screening strategies. A better understanding of the target lesion, improved design of biomarker discovery studies, a focus on detecting low volume disease using cancer specific markers, novel biospecimens such as cervical cytology and targeted imaging and use of time series algorithms for interpreting markers profile suggests that a new era in screening is underway.
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Affiliation(s)
- Usha Menon
- Gynaecological Cancer Research Centre, Women's Cancer, UCL EGA Institute for Women's Health, Maple House, 149 Tottenham Court Road, London W1T 7DN, UK.
| | - Michelle Griffin
- Gynaecological Cancer Research Centre, Women's Cancer, UCL EGA Institute for Women's Health, Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - Aleksandra Gentry-Maharaj
- Gynaecological Cancer Research Centre, Women's Cancer, UCL EGA Institute for Women's Health, Maple House, 149 Tottenham Court Road, London W1T 7DN, UK.
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