1
|
MacArthur E, Stone R. Current Science and Practice of Surgical and Nonsurgical Opportunities for Ovarian Cancer Prevention. Clin Obstet Gynecol 2024:00003081-990000000-00177. [PMID: 39344701 DOI: 10.1097/grf.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Due to improved understanding of ovarian cancer pathogenesis, we have an unprecedented chance to decrease the burden of disease by maximizing opportunities for prevention. Innovations in surgical options for prevention stem from the discovery that many cases directly or indirectly arise from the fallopian tube. Surgical prevention with salpingectomy alone decreases risk by ≥50%. Effective hormonal and nonhormonal chemopreventive agents are also available. Risk stratification is key to ensuring that options for prevention are appropriately matched to individual risk profile. This evidence-based review provides a critical appraisal of the translational health research endeavors supporting ovarian cancer prevention in clinical practice.
Collapse
Affiliation(s)
- Emily MacArthur
- Kelly Gynecologic Oncology Service, Johns Hopkins University, Baltimore, Maryland
| | | |
Collapse
|
2
|
Bonavina G, Busnelli A, Salmeri N, Cavoretto PI, Salvatore S, Candiani M, Bulfoni A. Opportunistic salpingectomy at the time of vaginal hysterectomy: A systematic review and meta-analysis. Int J Gynaecol Obstet 2024; 166:494-501. [PMID: 38247214 DOI: 10.1002/ijgo.15386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Despite the rising rates of opportunistic salpingectomy at the time of surgery for non-malignant conditions, salpingectomy is not widely adopted during vaginal hysterectomy (VH) and has not been extensively investigated. OBJECTIVES The aim of the primary study was to determine the feasibility of bilateral opportunistic salpingectomy at the time of VH. Secondary aims included surgical outcomes, factors associated with patient selection, and the prevalence of incidental tubal malignancies. SEARCH STRATEGY In this systematic review and meta-analysis we searched Pubmed, Embase and ClinicalTrials.gov databases from inception to September 1, 2023, using relevant keywords. SELECTION CRITERIA Original articles with no language restriction reporting outcomes of women undergoing planned VH with opportunistic salpingectomy, were considered eligible. Studies including patients undergoing VH with and without opportunistic salpingectomy were also included. DATA COLLECTION AND ANALYSIS The Newcastle-Ottawa scale was used to assess quality of observational studies. DerSimonian-Laird random effects meta-analysis was performed and pooled effect estimates and proportions with corresponding 95% confidence intervals were computed. Heterogeneity was assessed using the I2 statistic. RESULTS Seven observational cohort studies including 4808 women undergoing opportunistic salpingectomy at the time of VH and 10 295 patients undergoing VH alone were selected. The pooled proportion of success was 81.83 per 100 observations (95% CI: 75.35-87.54). Opportunistic salpingectomy at the time of VH, when feasible, was associated with a significant reduction in intraoperative complications (OR 0.06, 95% CI: 0.01, -0.37, P = 0.03) and total operative time (95% CI: -17.80, -1.07, P = 0.03) compared to those where it failed. Successful salpingectomy was significantly hindered by nulliparity (OR 0.12, 95% CI: -17.69, -1.21, P < 0.001) and favored by pelvic organ prolapse (OR 3.20, 95% CI: 1.35, 7.55, P = 0.008). Immunohistochemical tubal abnormalities were found in 13/579 (2.1%) patients. The overall quality of the evidence, according to the GRADE assessment, was low. CONCLUSION Opportunistic salpingectomy is safe, effective, and feasible at the time of VH. Nulliparity and pelvic organ prolapse are factors potentially influencing surgical outcomes.
Collapse
Affiliation(s)
- Giulia Bonavina
- Department of Obstetrics and Gynecology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrea Busnelli
- Department of Obstetrics and Gynecology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Noemi Salmeri
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy
| | - Paolo I Cavoretto
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy
| | - Alessandro Bulfoni
- Department of Obstetrics and Gynecology, IRCCS Humanitas Research Hospital, Milan, Italy
| |
Collapse
|
3
|
Mundhada PV, Bakshi AM, Thtipalli N, Yelne S. Unveiling the Promise: A Comprehensive Review of Salpingectomy as a Vanguard for Ovarian Cancer Prevention. Cureus 2024; 16:e53088. [PMID: 38414692 PMCID: PMC10897749 DOI: 10.7759/cureus.53088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/27/2024] [Indexed: 02/29/2024] Open
Abstract
This comprehensive review explores the potential of salpingectomy as a groundbreaking strategy for the prevention of ovarian cancer. The discussion encompasses the biological rationale behind salpingectomy, emphasizing its foundation in the tubal hypothesis, which posits the fallopian tubes as a possible origin site for certain ovarian cancers. Ongoing clinical trials and observational studies provide evolving evidence supporting the safety and efficacy of salpingectomy, particularly in high-risk populations. The procedure's ethical considerations, including its impact on fertility and equitable access, are thoroughly examined. Implications for clinical practice underscore the importance of informed decision-making, risk-benefit assessments, and the integration of emerging evidence into reproductive health discussions. Looking ahead, the future landscape of ovarian cancer prevention involves continued research, technological innovations, and collaborative efforts to ensure a holistic and evidence-based approach. The goal is to forge a future where ovarian cancer is not only treatable but also preventable, with salpingectomy potentially playing a pivotal role in this transformative journey.
Collapse
Affiliation(s)
- Priyal V Mundhada
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amey M Bakshi
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikhil Thtipalli
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Yelne
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
4
|
Matsuo K, Rau AR, Ciesielski KM, Vallejo A, Mandelbaum RS, Roman LD, Klar M, Matsushima K, Wright JD. Concurrent Minimally Invasive Gynecologic Procedures at the Time of Laparoscopic Cholecystectomy. Obstet Gynecol 2023; 142:1491-1495. [PMID: 37883996 DOI: 10.1097/aog.0000000000005420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/24/2023] [Indexed: 10/28/2023]
Abstract
In this cross-sectional study including 1,722,479 women who underwent laparoscopic cholecystectomy between January 2016 and December 2019 identified in the Healthcare Cost and Utilization Project's Nationwide Ambulatory Surgery Sample, the prevalence rate of gynecologic diagnoses was 11.3 per 1,000. Among presumed elective laparoscopic cholecystectomy, the highest performance rate of concurrent gynecologic procedure per gynecologic diagnosis was laparoscopic adnexectomy among patients with benign ovarian tumor (652/1,000 diagnoses), followed by laparoscopic adnexectomy for endometrioma (386/1,000 diagnoses) and cervical conization for cervical carcinoma in situ (304/1,000 diagnoses). The measured surgical morbidity rates for patients who had concurrent gynecologic surgery and those who did not were 2.8 per 1,000 and 1.9 per 1,000, respectively (adjusted odds ratio 1.39, 95% CI 0.75-2.59). These results suggest that minimally invasive gynecologic surgeries are being performed at the time of outpatient laparoscopic cholecystectomy in the United States.
Collapse
Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology and the Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, the Norris Comprehensive Cancer Center, the Keck School of Medicine, and the Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California; the Division of Minimally Invasive Surgery, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; the Department of Obstetrics and Gynecology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Sowamber R, Lukey A, Huntsman D, Hanley G. Ovarian Cancer: From Precursor Lesion Identification to Population-Based Prevention Programs. Curr Oncol 2023; 30:10179-10194. [PMID: 38132375 PMCID: PMC10742141 DOI: 10.3390/curroncol30120741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Epithelial ovarian cancer (EOC) is a heterogeneous group of malignancies, including high-grade serous ovarian cancer (HGSC). HGSC is often diagnosed at advanced stages and is linked to TP53 variants. While BRCA variants elevate risk, most HGSC cases occur in individuals without known genetic variants, necessitating prevention strategies for people without known high-risk genetic variants. Effective prevention programs are also needed due to the lack of traditional screening options. An emerging primary prevention strategy is opportunistic salpingectomy, which involves removing fallopian tubes during another planned pelvic surgery. Opportunistic salpingectomy offers a safe and cost-effective preventative option that is gaining global adoption. With the publication of the first cohort study of patients who underwent salpingectomy, specifically for cancer prevention, attention has turned to broadening opportunities for salpingectomy in addition to more targeted approaches. Prevention opportunities are promising with increasing adoption of salpingectomy and the increased understanding of the etiology of the distinct histotypes of ovarian cancer. Yet, further research on targeted risk-reducing salpingectomy with thoughtful consideration of equity is necessary to reduce death and suffering from ovarian cancer.
Collapse
Affiliation(s)
- Ramlogan Sowamber
- Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, BC V6T 1Z4, Canada
| | - Alexandra Lukey
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - David Huntsman
- Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, BC V6T 1Z4, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Gillian Hanley
- Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| |
Collapse
|
6
|
Kahn RM, Gordhandas S, Godwin K, Stone RL, Worley MJ, Lu KH, Roche KL. Salpingectomy for the Primary Prevention of Ovarian Cancer: A Systematic Review. JAMA Surg 2023; 158:1204-1211. [PMID: 37672283 PMCID: PMC11185162 DOI: 10.1001/jamasurg.2023.4164] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [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.
Collapse
Affiliation(s)
- Ryan M. Kahn
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sushmita Gordhandas
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rebecca L. Stone
- Department of Obstetrics and Gynecology, Johns Hopkins Hospital, Baltimore, MD
| | | | - Karen H. Lu
- Division of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| |
Collapse
|
7
|
Cathcart AM, Harrison R, Luccarelli J. Opportunistic salpingectomy during non-gynaecological surgery in the United States: a population-based retrospective study. Br J Surg 2023; 110:1215-1217. [PMID: 37463287 PMCID: PMC10416676 DOI: 10.1093/bjs/znad203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/01/2023] [Accepted: 06/11/2023] [Indexed: 07/20/2023]
Abstract
Lay Summary
The most common type of ovarian cancer likely begins in the fallopian tubes. Surgically removing the fallopian tubes decreases a person’s risk of ovarian cancer. ‘Opportunistic salpingectomy’ refers to the removal of the fallopian tubes during surgery that is done for other reasons. Opportunistic salpingectomy is commonly done during hysterectomy. The types of other surgery performed together with opportunistic salpingectomy in the USA were analysed in the present study. Opportunistic salpingectomy was found to be done at the time of bariatric surgery, bowel surgery, hernia repair, gallbladder surgery, and breast surgery. Offering opportunistic salpingectomy to all women who are scheduled for those types of surgeries could lead to between 3600 and 5800 fewer deaths from ovarian cancer in the USA per year.
Collapse
Affiliation(s)
- Ann M Cathcart
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Ross Harrison
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
- Division of Gynecologic Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Runnebaum IB, Kather A. Primary prevention of ovarian cancer by salpingectomy: that's one small step for a surgeon, one giant leap for patients. J Cancer Res Clin Oncol 2023; 149:6799-6801. [PMID: 36991197 PMCID: PMC10374736 DOI: 10.1007/s00432-023-04697-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Ingo B Runnebaum
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Angela Kather
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| |
Collapse
|
9
|
Rius M, Carugno J, Abrao MS, Carmona F. Opportunistic Salpingectomy for Ovarian Cancer Prevention: A Call for Action. J Am Coll Surg 2023; 237:376-378. [PMID: 37042549 DOI: 10.1097/xcs.0000000000000713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Mariona Rius
- From the Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Barcelona, Spain (Rius, Carmona)
| | - José Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Division, University of Miami, Miller School of Medicine, Miami, FL (Carugno)
| | - Maurico S Abrao
- Endometriosis Section, Gynecologic Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, and Department of Obstetrics and Gynaecology, Universidade de São Paulo, São Paulo, Brazil (Abrao)
- Gynecologic Division, BP - A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil (Abrao)
| | - Francisco Carmona
- From the Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Barcelona, Spain (Rius, Carmona)
| |
Collapse
|
10
|
Matsuo K, Chen L, Matsuzaki S, Mandelbaum RS, Ciesielski KM, Silva JP, Klar M, Roman LD, Accordino MK, Melamed A, Elkin E, Hershman DL, Wright JD. Opportunistic Salpingectomy at the Time of Laparoscopic Cholecystectomy for Ovarian Cancer Prevention: A Cost-effectiveness Analysis. Ann Surg 2023; 277:e1116-e1123. [PMID: 35129467 DOI: 10.1097/sla.0000000000005374] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To perform a cost-effectiveness analysis to examine the utility and effectiveness of OS performed at the time of elective cholecystectomy [laparoscopic cholecystectomy (LAP-CHOL)]. SUMMARY BACKGROUND DATA OS has been adopted as a strategy to reduce the risk of ovarian cancer in women undergoing hysterectomy and tubal sterilization, although the procedure is rarely performed as a risk reducing strategy during other abdominopelvic procedures. METHODS A decision model was created to examine women 40, 50, and 60 years of age undergoing LAP-CHOL with or without OS. The lifetime risk of ovarian cancer was assumed to be 1.17%, 1.09%, and 0.92% for women age 40, 50, and 60 years, respectively. OS was estimated to provide a 65% reduction in the risk of ovarian cancer and to require 30 additional minutes of operative time. We estimated the cost, quality-adjusted life-years, ovarian cancer cases and deaths prevented with OS. RESULTS The additional cost of OS at LAP-CHOL ranged from $1898 to 1978. In a cohort of 5000 women, OS reduced the number of ovarian cancer cases by 39, 36, and 30 cases and deaths by 12, 14, and 16 in the age 40-, 50-, and 60-year-old cohorts, respectively. OS during LAP-CHOL was cost-effective, with incremental cost-effectiveness ratio of $11,162 to 26,463 in the 3 age models. In a probabilistic sensitivity analysis, incremental cost-effectiveness ratio for OS were less than $100,000 per quality-adjusted life-years in 90.5% or more of 1000 simulations. CONCLUSIONS OS at the time of LAP-CHOL may be a cost-effective strategy to prevent ovarian cancer among average risk women.
Collapse
Affiliation(s)
- Koji Matsuo
- University of Southern California, Los Angeles, CA
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, New York, NY
| | | | | | | | - Jack P Silva
- University of Southern California, Los Angeles, CA
| | - Maximilian Klar
- University of Freiburg Faculty of Medicine, Freiburg im Breisgau, Germany; and
| | | | | | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Elena Elkin
- Joseph L. Mailman School of Public Health, Columbia University, New York, NY
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, NY
- Joseph L. Mailman School of Public Health, Columbia University, New York, NY
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, NY
| |
Collapse
|
11
|
Dukhovich A, Sullivan ME, Hartnett J, Rose SJ, Hines BJ. Opportunistic salpingectomy during robotic sacrocolpopexy: Data to support a widely accepted practice. Data Brief 2023; 46:108891. [PMID: 36687155 PMCID: PMC9852919 DOI: 10.1016/j.dib.2023.108891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Abstract
While surgical outcomes of prophylactic salpingectomy as an ovarian cancer risk reducing measure at the time of hysterectomy for benign indications has already been studied, data has traditionally been extrapolated to surgery for prolapse repair. A retrospective chart review was performed from medical records of patients who had undergone a sacrocolpopexy for pelvic organ prolapse. Variables collected included operation duration, length of hospital stay, readmission within 31 days, estimated blood loss (EBL), number and size of incisions, as well as narcotic use during hospitalization. Additional procedures performed at the time of operation including vaginal or laparoscopic hysterectomy, transobturator sling, anterior or posterior colporrhaphy, cystoscopy, and robotic ventral mesh rectopexy were collected as potential confounding variables. In addition, data to allow examination of pathology results of all fallopian tubes was collected to determine the proportion of pre-malignant and malignant pathology results. Statistical analyses were performed using SAS version 8. Two cohorts were created: (1) Patients who underwent adnexal surgery (bilateral salpingectomy or salpingoopherectomy) at time of the sacrocolpopexy and (2) Patients who underwent a sacrocolpopexy without adnexal surgery. Comparisons were performed with chi-square analysis for discrete variables and group t-tests for continuous level data. Narcotics administered during the immediate post-operative period until discharge was collected for each patient and converted to morphine milligram equivalents (MME) via multiplying the administered dose by the CDC established evidence-based conversion factor. Analysis of covariance (ANCOVA) as well as logistic regression was used to control for confounding variables, including the additional procedures patients had during their operation. An omnibus p-value of 0.05 was used to determine statistical significance for all tests. Due to the exploratory nature of this analysis, there were no corrections applied for multiple comparisons. This data can be used as a basis for researchers to build upon when assessing ovarian cancer primary prevention strategies and associated treatment modalities.
Collapse
Affiliation(s)
- Anna Dukhovich
- Department of Female Pelvic Medicine and Reconstructive Surgery, Montefiore Health System, New York, New York, United States
| | - Marie E. Sullivan
- Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, Connecticut, United States
| | - Josette Hartnett
- Department of Research and Discovery, Stamford Hospital, Stamford, Connecticut, United States
| | - Suzanne J. Rose
- Department of Research and Discovery, Stamford Hospital, Stamford, Connecticut, United States
- Corresponding author.
| | - Brian J. Hines
- Department of Urogynecology and Reconstructive Surgery, Stamford Hospital, Stamford, Connecticut, United States
| |
Collapse
|
12
|
Linz VC, Löwe A, van der Ven J, Hasenburg A, Battista MJ. Incidence of pelvic high-grade serous carcinoma after isolated STIC diagnosis: A systematic review of the literature. Front Oncol 2022; 12:951292. [PMID: 36119503 PMCID: PMC9472545 DOI: 10.3389/fonc.2022.951292] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion of pelvic high-grade serous carcinoma (HGSC). Information on treatment and outcome of isolated STIC is rare. Therefore, we reviewed systematically the published literature to determine the incidence of subsequent HGSC in the high- and low-risk population and to summarize the current diagnostic and therapeutic options. Methods A systematic review of the literature was conducted in MEDLINE-Ovid, Cochrane Library and Web of Science of articles published from February 2006 to July 2021. Patients with an isolated STIC diagnosis and clinical follow-up were included. Study exclusion criteria for review were the presence of synchronous gynaecological cancer and/or concurrent non-gynaecological malignancies. Results 3031 abstracts were screened. 112 isolated STIC patients out of 21 publications were included in our analysis with a pooled median follow-up of 36 (interquartile range (IQR): 25.3-84) months. 71.4% of the patients had peritoneal washings (negative: 62.5%, positive: 8%, atypic cells: 0.9%). Surgical staging was performed in 28.6% of all STICs and did not show any malignancies. 14 out of 112 (12.5%) patients received adjuvant chemotherapy with Carboplatin and Paclitaxel. Eight (7.1%) patients developed a recurrence 42.5 (IQR: 33-72) months after isolated STIC diagnosis. Cumulative incidence of HGSC after five (ten) years was 10.5% (21.6%). Recurrence occurred only in BRCA1 carriers (seven out of eight patients, one patient with unknown BRCA status). Conclusion The rate of HGSC after an isolated STIC diagnosis was 7.1% with a cumulative incidence of 10.5% (21.6%) after five (ten) years. HGSC was only observed in BRCA1 carriers. The role of adjuvant therapy and routine surveillance remains unclear, however, intense surveillance up to ten years is necessary. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021278340.
Collapse
|
13
|
Bogaerts JMA, Steenbeek MP, van Bommel MHD, Bulten J, van der Laak JAWM, de Hullu JA, Simons M. Recommendations for diagnosing STIC: a systematic review and meta-analysis. Virchows Arch 2022; 480:725-737. [PMID: 34850262 PMCID: PMC9023413 DOI: 10.1007/s00428-021-03244-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 12/12/2022]
Abstract
Our understanding of the oncogenesis of high-grade serous cancer of the ovary and its precursor lesions, such as serous tubal intraepithelial carcinoma (STIC), has significantly increased over the last decades. Adequate and reproducible diagnosis of these precursor lesions is important. Diagnosing STIC can have prognostic consequences and is an absolute requirement for safely offering alternative risk reducing strategies, such as risk reducing salpingectomy with delayed oophorectomy. However, diagnosing STIC is a challenging task, possessing only moderate reproducibility. In this review and meta-analysis, we look at how pathologists come to a diagnosis of STIC. We performed a literature search identifying 39 studies on risk reducing salpingo-oophorectomy in women with a known BRCA1/2 PV, collectively reporting on 6833 patients. We found a pooled estimated proportion of STIC of 2.8% (95% CI, 2.0-3.7). We focused on reported grossing protocols, morphological criteria, level of pathologist training, and the use of immunohistochemistry. The most commonly mentioned morphological characteristics of STIC are (1) loss of cell polarity, (2) nuclear pleomorphism, (3) high nuclear to cytoplasmic ratio, (4) mitotic activity, (5) pseudostratification, and (6) prominent nucleoli. The difference in reported incidence of STIC between studies who totally embedded all specimens and those who did not was 3.2% (95% CI, 2.3-4.2) versus 1.7% (95% CI, 0.0-6.2) (p 0.24). We provide an overview of diagnostic features and present a framework for arriving at an adequate diagnosis, consisting of the use of the SEE-FIM grossing protocol, evaluation by a subspecialized gynecopathologist, rational use of immunohistochemical staining, and obtaining a second opinion from a colleague.
Collapse
Affiliation(s)
- Joep M A Bogaerts
- Department of Pathology, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Miranda P Steenbeek
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Majke H D van Bommel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Joanne A de Hullu
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel Simons
- Department of Pathology, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
14
|
van Lieshout LA, Gelderblom ME, de Hullu JA, The R, van Ginkel AA, Oerlemans AJ, Smeets KM, Schreurs MP, Piek JM, Hermens RP. Primary prevention of ovarian cancer: a patient decision aid for opportunistic salpingectomy. Am J Obstet Gynecol 2022; 226:234.e1-234.e14. [PMID: 34536392 DOI: 10.1016/j.ajog.2021.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/17/2021] [Accepted: 09/08/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The discovery of the fallopian tube epithelium as the origin of high-grade serous ovarian cancer has brought a new option for ovarian cancer prevention. The fallopian tubes have no known function after completion of childbearing and can be removed to reduce the lifetime risk of ovarian cancer. Although the lifetime risk in the general population does not justify preventive surgery in itself, salpingectomy can be performed during abdominal surgery for other indications, also known as an opportunistic salpingectomy. The popularity of opportunistic salpingectomy is increasing worldwide; however, the variation between gynecologists and hospitals in their advice on opportunistic salpingectomy occurs because of the remaining uncertainty of evidence. Therefore, whether a woman can make her own decision depends on the hospital or gynecologist she visits. We aimed to lower this practice variation by providing standardized and unbiased counseling material. OBJECTIVE We aimed to develop and test a patient decision aid for opportunistic salpingectomy in women undergoing pelvic gynecologic surgery to either retain the ovaries or opt for sterilization. STUDY DESIGN We followed a systematic development process based on the International Patient Decision Aid Standards. Data were collected between June 2019 and June 2020, using both qualitative and quantitative methods. The development process that occurred in collaboration with patients and healthcare professionals was overseen by a multidisciplinary steering group and was divided into 4 phases: (1) assessment of decisional needs using individual telephone interviews and questionnaires; (2) development of content and format based on decisional needs, current literature, and guidelines; (3) alpha testing and the first revision round; and (4) alpha testing and the second revision round. RESULTS An outline of the patient decision aid was developed on the basis of decisional needs, current literature, and guidelines. It became clear that the decision aid should consist of 2 separate paths: one with information specifically for salpingectomy in addition to abdominal surgery and one for salpingectomy as a sterilization method. Both paths contained information on the anatomy and function of ovaries and fallopian tubes, risk reduction of ovarian cancer, and potential benefits and risks of opportunistic salpingectomy. Moreover, the sterilization path contains information on various sterilization methods and risks of unwanted pregnancy. The patient decision aid was developed as an online tool that includes information chapters, a knowledge quiz, consideration statements, and a summary detailing the patient's preferences and considerations. Adjustments were made following alpha testing round 1. The improved patient decision aid was subjected to usability tests (alpha testing round 2), in which it scored an "excellent" in tests with patients and a "good" in tests with gynecologists. Furthermore, our patient decision aid met the requirements of 45 of 49 applicable items from the International Patient Decision Aid Standards criteria. CONCLUSION In collaboration with patients and healthcare professionals, a patient decision aid was developed on opportunistic salpingectomy and salpingectomy as a sterilization method. Both patients and gynecologists believed it is a useful tool that supports patients in making an informed decision whether to undergo an opportunistic salpingectomy and supports the counseling process by gynecologists.
Collapse
|
15
|
El Bairi K, Al Jarroudi O, Le Page C, Afqir S. Does the "Devil" originate from the fallopian tubes? Semin Cancer Biol 2021; 77:56-66. [PMID: 33766647 DOI: 10.1016/j.semcancer.2021.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/14/2021] [Accepted: 03/20/2021] [Indexed: 02/08/2023]
Abstract
Epithelial ovarian cancer (OC) is a heterogeneous disease and continues to be mostly diagnosed in advanced stages. The high lethality, the high rate of platinum-resistance, and the poor survival outcomes are the principal factors for categorizing OC among the most aggressive gynecological cancers. Only recently, a substantial progress has been made in our latest understanding of the origins of OC, particularly of high-grade serous histology. For a long time, the accumulation of genetic alterations in epithelial single layer cells of ovarian cysts caused by cyclic ovulations was considered as the most important driver and the long-standing dogma of ovarian tumorigenesis. Besides, the unique biological features and high histological heterogeneity of OC did not support this hypothesis. Indeed, various extra-ovarian cells of origin and multiple sites to each histotype were proposed, supported by cogent evidence from clinical cohorts and animal studies. In light of this enigma, this review was conducted to discuss the recent evidence supporting the revised origins of ovarian carcinoma histotypes with a particular focus on high-grade serous OC which may impact diagnostic and preventive approaches.
Collapse
Affiliation(s)
- Khalid El Bairi
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco.
| | - Ouissam Al Jarroudi
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco
| | - Cécile Le Page
- Research Institute of McGill University Health Center (RI-MUHC), Montréal, QC, Canada
| | - Said Afqir
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco
| |
Collapse
|
16
|
van der Meer R, Bakkers C, Rostamkhan E, de Hingh I, Roumen R. Ovarian metastases from colorectal cancer in young women: a systematic review of the literature. Int J Colorectal Dis 2021; 36:2567-2575. [PMID: 34432125 DOI: 10.1007/s00384-021-04012-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE In female colorectal cancer patients, a mean proportion of synchronous and/or metachronous ovarian metastases of 3.4% was described. Previous literature showed that young or premenopausal women (≤ 55 years of age) may be more frequently affected. Once ovarian metastases are diagnosed, the prognosis of the patient is generally dismal, with 5-year survival varying from 12 to 27%. The present study is aimed at determining the proportion of young or premenopausal women diagnosed with colorectal cancer who presented with or developed ovarian metastases by reviewing the current literature on this topic. METHODS This review was performed by querying MEDLINE and EMBASE databases using a combination of terms: "colorectal neoplasms, colorectal cancer, ovarian neoplasms, Krukenberg tumor, young adult, young age, premenopause." Studies that indicated ovarian metastases, either synchronous or metachronous (or a combination of the two), in young women were retrieved and analyzed. RESULTS The review identified 14 studies encompassing 3379 young or premenopausal female colorectal cancer patients. In this selected group of patients, a mean proportion of ovarian metastases of 4.6% [95% CI: 4.0;5.4] was found. CONCLUSIONS This review showed that approximately one in twenty young female colorectal cancer patients will present with or develop ovarian metastases. Since outcome of this specific oncological pathology is often dismal, this finding is clinically relevant. It demonstrates the need to develop strategies to lower the incidence of ovarian metastases with adequate treatment and counseling of these patients.
Collapse
Affiliation(s)
- Richard van der Meer
- Department of Surgery, Máxima Medical Center, PO BOX 7777, 5500 MB, Veldhoven, Netherlands.
| | - Checca Bakkers
- Department of Surgery, Catharina Cancer Institute, Eindhoven, Netherlands
| | - Elysa Rostamkhan
- Department of Surgery, Máxima Medical Center, PO BOX 7777, 5500 MB, Veldhoven, Netherlands
| | - Ignace de Hingh
- Department of Surgery, Catharina Cancer Institute, Eindhoven, Netherlands.,GROW - School for Oncology and Development Biology, Maastricht University, Maastricht, Netherlands
| | - Rudi Roumen
- Department of Surgery, Máxima Medical Center, PO BOX 7777, 5500 MB, Veldhoven, Netherlands.,GROW - School for Oncology and Development Biology, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
17
|
Weiwei Z, Ya X, Wenwen W, Jia J, Jing B, Ruitao Z, Chunfang W, Ruixia G. IGF-1R anti-idiotypic antibody antagonist exhibited anti-ovarian cancer bioactivity and reduced cisplatin resistance. Hum Cell 2021; 34:1197-1214. [PMID: 33905103 DOI: 10.1007/s13577-021-00535-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
Ovarian cancer is the most deadly gynecological malignant tumor in the world today. Previous studies have shown that insulin-like growth factor-1 receptor (IGF-1R) is closely related to the occurrence and development of ovarian cancer, and ovarian cancer cells endogenously express high IGF-1R. Therefore, IGF-1R could be used as a target for ovarian cancer treatment. In the past, the strategy for preparing IGF-1R antagonists was to use IGF-1R antibody and small-molecule inhibitor. In the current research, we use a new method to prepare IGF-1R antagonists. We prepared a series of IGF-1 internal imaging anti-idiotypic antibodies by anti-idiotypic antibody strategy. After a series of screening and identification, one of the anti-idiotypic antibodies (B003-2A) was selected for further evaluation, and the results showed that B003-2A could not only inhibit the binding of IGF-1 to IGF-1R but also inhibit the signaling mediated by IGF-1R. Further work showed that B003-2A inhibited the proliferation of ovarian cancer cells in vivo and in vitro. In addition, the current study also indicates that B003-2A could enhance the sensitivity of cisplatin in cisplatin-resistant ovarian cancer cell lines. In summary, our research shows that B003-2A can be used to treat ovarian cancer. The current study also laid the foundation for the development of IGF-1R antagonist.
Collapse
Affiliation(s)
- Zhang Weiwei
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, 1st Jianshe East Road, Zhengzhou, China
- Laboratory of Gynecological Malignant Tumor Prevention and Treatment of Henan Province, Zhengzhou, China
| | - Xie Ya
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, 1st Jianshe East Road, Zhengzhou, China
| | - Wang Wenwen
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, 1st Jianshe East Road, Zhengzhou, China
| | - Jia Jia
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, 1st Jianshe East Road, Zhengzhou, China
| | - Bai Jing
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, 1st Jianshe East Road, Zhengzhou, China
| | - Zhang Ruitao
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, 1st Jianshe East Road, Zhengzhou, China
| | - Wang Chunfang
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, 1st Jianshe East Road, Zhengzhou, China
- Laboratory of Gynecological Malignant Tumor Prevention and Treatment of Henan Province, Zhengzhou, China
| | - Guo Ruixia
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, 1st Jianshe East Road, Zhengzhou, China.
- Laboratory of Gynecological Malignant Tumor Prevention and Treatment of Henan Province, Zhengzhou, China.
| |
Collapse
|
18
|
Falconer H, Yin L, Salehi S, Altman D. Association between pelvic inflammatory disease and subsequent salpingectomy on the risk for ovarian cancer. Eur J Cancer 2021; 145:38-43. [PMID: 33418235 DOI: 10.1016/j.ejca.2020.11.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
AIM Salpingectomy is associated with a lower risk for ovarian cancer, suggesting that the fallopian tubes constitute the origin of the disease. It is unclear whether the observed effect is mediated by pelvic inflammatory disease (PID); a major indication for salpingectomy and implicated in the aetiology of ovarian cancer. METHODS In this population-based cohort study, we used nationwide registry-based data on women exposed for PID with and without subsequent salpingectomy (n = 97,912) compared with the unexposed population (n = 5,429,174) between 1973 and 2010. The effect of hormone treatment was considered in a subanalysis. RESULTS Of the exposed women, 9538 women underwent salpingectomy during the study period. There was a significant association between PID and ovarian cancer (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.31-1.59), whereas an inverse association was observed for exposed women with subsequent salpingectomy (HR 0.55, 95% CI 0.36-0.83). Salpingectomy performed on other indications (n = 24,895) was associated with a lower incidence of ovarian cancer (HR 0.72, 95% CI 0.56-0.93). No effect modification was observed for the use of oral contraceptives or hormonal replacement therapy. CONCLUSION Salpingectomy is associated with a lower incidence of ovarian cancer regardless of indication.
Collapse
Affiliation(s)
- Henrik Falconer
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
| | - Li Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sahar Salehi
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Altman
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| |
Collapse
|
19
|
Riedinger CJ, Zite NB, Overby DW, Robinson EF, Moulder JK. Optimizing contraceptive access for women undergoing bariatric surgery. Surg Obes Relat Dis 2020; 16:2082-2087. [PMID: 33004300 DOI: 10.1016/j.soard.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/27/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
With the dramatic increase in the prevalence of obesity, there is a corresponding increase in surgical procedures to treat obesity. Reproductive aged women (18-45 years old) undergo half of the bariatric surgical procedures performed in the United States each year. These women experience profound physiologic changes in response to bariatric surgery, including dramatic changes in reproductive function. Current guidelines recommend delaying attempts at conception for 12-24 months after bariatric surgery during the time of most profound weight loss. Despite these recommendations, many women report unprotected intercourse during this time, and many use less efficacious contraceptive options. Herein, we address contraceptive considerations in women of reproductive age who undergo bariatric surgery and opportunities to maximize a multidisciplinary surgical approach to optimize their overall health.
Collapse
Affiliation(s)
- Courtney J Riedinger
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee.
| | - Nikki B Zite
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - David Wayne Overby
- Department of Surgery, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Erica F Robinson
- Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Janelle K Moulder
- Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
20
|
Bonavina G, Bocciolone L, Candiani M, Bonavina L. Comment on: Prophylactic salpingectomy for prevention of ovarian cancer at the time of elective laparoscopic cholecystectomy. Br J Surg 2020; 107:e354. [PMID: 32567684 DOI: 10.1002/bjs.11768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 11/05/2022]
Affiliation(s)
- G Bonavina
- Department of Gynecology, San Raffaele Hospital and University Vita e Salute, Milan, Italy
| | - L Bocciolone
- Department of Gynecology, San Raffaele Hospital and University Vita e Salute, Milan, Italy
| | - M Candiani
- Department of Gynecology, San Raffaele Hospital and University Vita e Salute, Milan, Italy
| | - L Bonavina
- Department of General Surgery, IRCCS Policlinico San Donato, University of Milano, Milan, Italy
| |
Collapse
|