Prophylactic salpingectomy in premenopausal low-risk women for ovarian cancer: Primum non nocere

被引:154
作者
Morelli, Michele [1 ]
Venturella, Roberta [1 ]
Mocciaro, Rita [1 ]
Di Cello, Annalisa [1 ]
Rania, Erika [1 ]
Lico, Daniela [1 ]
D'Alessandro, Pietro [1 ]
Zullo, Fulvio [1 ]
机构
[1] Magna Graecia Univ Catanzaro, Dept Obstet & Gynaecol, Gynecol Oncol Unit, Tommaso Campanella Canc Ctr Germaneto, I-88100 Catanzaro, Italy
关键词
High Grade Serous Ovarian Cancer; Prophylactic bilateral salpingectomy; Ovarian Reserve; Cancer prevention; FALLOPIAN-TUBE; BILATERAL OOPHORECTOMY; BRCA; HYSTERECTOMY; TIME; PATHOGENESIS; CARCINOMA; CARRIERS; FIMBRIA; ORIGIN;
D O I
10.1016/j.ygyno.2013.03.023
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Objective. The objective of this study is to compare ovarian function and surgical outcomes between patients affected by benign uterine pathologies submitted to total laparoscopic hysterectomy (TLH) plus salpingectomy and women in which standard TLH with adnexal preservation was performed. Methods. We retrospectively compared data of 79 patients who underwent TLH plus bilateral salpingectomy (group A), with those of 79 women treated by standard TLH without adnexectomy (sTLH) (group B). Ovarian reserve modification, expressed as the difference between 3 months post-operative and pre-operative values of Anti-Mullerian Hormone (AMH), Follicle Stimulating Hormone (FSH), Antral Follicle Count (AFC), mean ovarian diameters and Peak Systolic Velocity (PSV), was recorded for each patient For each surgical procedure, operative time, variation of hemoglobin level (Delta Hb), postoperative hospital stay, postoperative return to normal activity, and complication rate were recorded as secondary outcomes. Results. According to our post-hoc analysis, this equivalence study resulted to have a statistical power of 96.8%. Significant difference was not observed between groups with respect to Delta AMH (p = 0.35), Delta FSH (p = 0.15), Delta AFC (p = 0.09), A mean ovarian diameters (p = 0.57) and Delta PSV (p = 0.61). In addition, secondary outcomes such as operative time (p = 0.79), Delta Hb (p 0.41), postoperative hospital stay (p = 0.16), postoperative return to normal activity (p = 0.11) and complication rate also did not show any significant difference. Conclusions. The addition of bilateral salpingectomy to TLH for prevention of ovarian cancer in women who, do not carry a BRCA1/2 mutations do not show negative effects on the ovarian function. In addition, no perioperative complications are related to the salpingectomy step in TLH. (C) 2013 Elsevier Inc. All rights reserved.
引用
收藏
页码:448 / 451
页数:4
相关论文
共 32 条
[1]  
ACOG, 2008, Obstet Gynecol, V111, P231, DOI 10.1097/01.AOG.0000291580.39618.cb
[2]   New Insights Into the Pathogenesis of Ovarian Carcinoma Time to Rethink Ovarian Cancer Screening [J].
Chan, Angela ;
Gilks, Blake ;
Kwon, Janice ;
Tinker, Anna V. .
OBSTETRICS AND GYNECOLOGY, 2012, 120 (04) :935-940
[3]   Impaired ovarian blood flow and reduced antral follicle count following laparoscopic salpingectomy for ectopic pregnancy [J].
Chan, CCW ;
Ng, EHY ;
Li, CF ;
Ho, PC .
HUMAN REPRODUCTION, 2003, 18 (10) :2175-2180
[4]   Lessons from BRCA: The Tubal Fimbria Emerges as an Origin for Pelvic Serous Cancer [J].
Crum, Christopher P. ;
Drapkin, Ronny ;
Kindelberger, David ;
Medeiros, Fabiola ;
Miron, Alexander ;
Lee, Yonghee .
CLINICAL MEDICINE & RESEARCH, 2007, 5 (01) :35-44
[5]   The distal fallopian tube: a new model for pelvic serous carcinogenesis [J].
Crum, Christopher P. ;
Drapkin, Ronny ;
Miron, Alexander ;
Ince, Tan A. ;
Muto, Michael ;
Kindelberger, David W. ;
Lee, Yonghee .
CURRENT OPINION IN OBSTETRICS & GYNECOLOGY, 2007, 19 (01) :3-9
[6]   BRCA, the Oviduct, and the Space and Time Continuum of Pelvic Serous Carcinogenesis [J].
Crum, Christopher P. ;
McKeon, Frank D. ;
Xian, Wa .
INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, 2012, 22 :S29-S34
[7]   The post-reproductive Fallopian tube: better removed? [J].
Dietl, J. ;
Wischhusen, J. ;
Haeusler, S. F. M. .
HUMAN REPRODUCTION, 2011, 26 (11) :2918-2924
[8]   Risk of myocardial infarction after oophorectomy and hysterectomy [J].
Falkeborn, M ;
Schairer, C ;
Naessén, T ;
Persson, I .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 2000, 53 (08) :832-837
[9]   Ovarian androgen production in postmenopausal women [J].
Fogle, Robin H. ;
Stanczyk, Frank Z. ;
Zhang, Xiaohua ;
Paulson, Richard J. .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2007, 92 (08) :3040-3043
[10]  
HALME J, 1982, FERTIL STERIL, V38, P621