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Buffeteau A, Tanguy Le Gac Y, Weyl A, Chantalat E, Guerby P, Vidal F. Rationale for opportunistic salpingectomy during gynecological surgery for a benign condition: A review of the available literature. J Gynecol Obstet Hum Reprod 2020; 49:101829. [PMID: 32534217 DOI: 10.1016/j.jogoh.2020.101829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Recent discoveries have shed light on the benefits of opportunistic salpingectomy in the prevention of ovarian cancer. However, in this time of increasing interest in the parameters of ovarian reserve, there are no national recommendations on the subject. This literature review provides an enlightened look at the rationale for performing an opportunistic salpingectomy. OBJECTIVES To evaluate the benefits and risks associated with opportunistic salpingectomy during surgery for a benign gynecological condition. MATERIAL AND METHODS We carried out a systematic review of the literature using the Pubmed/Medline search engine and the Cochrane database. RESULTS A total of 61 articles were selected from over 300 references. The protective impact against cancer, which is widely demonstrated in the literature, is proof of the benefit of this procedure. Furthermore, no increase in intraoperative morbidity has been noted. However, the clinical impact on the ovarian reserve remains uncertain (in particular the occurrence of early pre-menopausal symptoms during the perimenopausal period). Nonetheless, the socioeconomic analysis supports performing opportunistic salpingectomy. CONCLUSION Performing opportunistic salpingectomy does not appear to cause an increase in morbidity but the impact on ovarian function is uncertain. The fact that there is a proven benefit of such a procedure against cancer indicates that prior to any surgery a clear discussion should be held with the patient in which they should be fully informed.
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Affiliation(s)
- Aurélie Buffeteau
- CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Paule de Viguier, 31059 Toulouse, France.
| | - Yann Tanguy Le Gac
- CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Paule de Viguier, 31059 Toulouse, France
| | - Ariane Weyl
- CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Rangueil, 31059 Toulouse, France
| | - Elodie Chantalat
- CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Rangueil, 31059 Toulouse, France
| | - Paul Guerby
- CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Paule de Viguier, 31059 Toulouse, France
| | - Fabien Vidal
- CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Paule de Viguier, 31059 Toulouse, France; Université Toulouse III, IRIT, CNRS UMR 5505, Toulouse, France
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Chene G, Cerruto E, Moret S, Lebail-Carval K, Chabert P, Mellier G, Nohuz E, Lamblin G, Clark TJ. Quality of life after laparoscopic removal of Essure ® sterilization devices. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100054. [PMID: 31404292 PMCID: PMC6687440 DOI: 10.1016/j.eurox.2019.100054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/11/2019] [Accepted: 05/19/2019] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To assess changes in quality of life after laparoscopic removal of Essure® sterilization devices (Bayer AG, Leverkusen, Germany). STUDY DESIGN In this prospective observational study in an academic research hospital, 80 women with new or worsening symptoms since placement of Essure® sterilization devices undergoing subsequent surgical removal were included. Laparoscopic removal of Essure® devices and salpingectomy with or without cornual excision were performed. Concomitant uterine procedures could be associated where indicated for gynaecological complaints. Comparison using the T student test for coupled series was done in this before-and-after study. RESULTS Health related quality of life (HRQL) was the primary outcome measured by the Short Form 12 (SF-12) questionnaire and a global 10 cm visual analogue scale (VAS). Secondary outcomes included assessment of pain, using continuous (VAS) and ordinal scales (Modified McGill Pain Questionnaire), menstrual bleeding (pictorial blood loss assessment chart (PBAC) score) and surgical feasibility and safety. There was a significant improvement in quality of life in both mental and physical health aspects of the SF-12 (34.02 (+/-1.19) vs. 49.61 (+/-1.42, P < .0001) and 36.55 (+/-0.99) vs. 43.32 (+/-1.18, P < .0001 respectively) as well as global VAS assessment (+2.91 (SD +/-0.27)) at the end of the first post-operative month. These improvements were maintained at three and six months. Mean pain decreased at one month following surgery compared to baseline (VAS 3.6 (+/-0.36) to 1.4 (+/-0.25), P < .0001 and McGill pain score 18.70 (+/-1.88) to 4.73 (+/-0.90), P < .0001). Improvements of a similar magnitude were observed when analysis was restricted to the 47 women without concomitant uterine surgery. No significant changes in bleeding were seen following of Essure® device removal. Planned procedures were all successfully completed. CONCLUSION Laparoscopic removal of Essure® devices in symptomatic women is technically successful and associated with short and medium-term improvement in quality of life as well as reduction in pelvic pain.
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Affiliation(s)
- Gautier Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, 59 boulevard Pinel, Universitary hospital of Lyon, 69000 Lyon, France
- Claude Bernard University of Lyon 1, EMR 3738, 69000 Lyon, France
| | - Emanuele Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, 59 boulevard Pinel, Universitary hospital of Lyon, 69000 Lyon, France
| | - Stephanie Moret
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, 59 boulevard Pinel, Universitary hospital of Lyon, 69000 Lyon, France
| | - Karine Lebail-Carval
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, 59 boulevard Pinel, Universitary hospital of Lyon, 69000 Lyon, France
| | - Philippe Chabert
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, 59 boulevard Pinel, Universitary hospital of Lyon, 69000 Lyon, France
| | - Georges Mellier
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, 59 boulevard Pinel, Universitary hospital of Lyon, 69000 Lyon, France
| | - Erdogan Nohuz
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, 59 boulevard Pinel, Universitary hospital of Lyon, 69000 Lyon, France
| | - Gery Lamblin
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, 59 boulevard Pinel, Universitary hospital of Lyon, 69000 Lyon, France
| | - T. Justin Clark
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children’s Hospital, Birmingham, B15 2TG, UK
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An Alternate Diagnostic Algorithm for the Diagnosis of Intraepithelial Fallopian Tube Lesions. Int J Gynecol Pathol 2019; 39:261-269. [PMID: 31033800 DOI: 10.1097/pgp.0000000000000604] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intraepithelial fallopian tube neoplasia is thought to be a precursor lesion to high-grade serous carcinoma of the Müllerian adnexae, particularly in women with BRCA1 or BRCA2 mutations. This association has led to recommendations to assess fallopian tubes for intraepithelial atypia. However, the diagnostic reproducibility of a diagnosis of intraepithelial neoplasia is unclear. In this study, 2 gynecologic pathologists independently evaluated sections of fallopian tubes from a sample of women (N=198, 623 slides) undergoing salpingectomy. A total of 101 (54%) women were undergoing risk-reducing salpingo-oophorectomy. Pathologists were blinded to patient histories and prior diagnoses. Pathologists rendered one of three diagnoses for each slide: "negative for fallopian tube intraepithelial neoplasia (FTIN)," "indeterminate for FTIN," or "definite for FTIN." Cases that were considered by histology definite for FTIN or suspicious for FTIN were stained with p53 and Ki67. Pathologists agreed on the diagnosis of "definite for FTIN" 61.5% of the time. There was no agreement on any cases for the diagnosis of "indeterminate for FTIN." Fifteen "indeterminate for FTIN" and 12 "definite for FTIN" cases were stained with p53 and Ki67. Two of the "indeterminate" cases (13%) had p53-positive foci. Five of the "definite" cases had p53-positive foci. In 3 of the other 8 "definite" cases, there was obvious carcinoma present, but the carcinoma did not stain with p53, suggesting a possible null phenotype. We propose that immunostains should only be used to aid in the diagnosis of FTIN in cases with indeterminate histology. The use of p53 immunohistochemistry in cases that were considered "definite for FTIN" by histology was minimally helpful, and in fact often served to further confuse the diagnosis.
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