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Bowen CM, Demarest K, Vilar E, Shah PD. Novel Cancer Prevention Strategies in Individuals With Hereditary Cancer Syndromes: Focus on BRCA1, BRCA2, and Lynch Syndrome. Am Soc Clin Oncol Educ Book 2024; 44:e433576. [PMID: 38913968 DOI: 10.1200/edbk_433576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Germline pathogenic variants (PVs) in the BRCA1 and BRCA2 genes confer elevated risks of breast, ovarian, and other cancers. Lynch syndrome (LS) is associated with increased risks of multiple cancer types including colorectal and uterine cancers. Current cancer risk mitigation strategies have focused on pharmacologic risk reduction, enhanced surveillance, and preventive surgeries. While these approaches can be effective, they stand to be improved on because of either limited efficacy or undesirable impact on quality of life. The current review summarizes ongoing investigational efforts in cancer risk prevention strategies for patients with germline PVs in BRCA1, BRCA2, or LS-associated genes. These efforts span radiation, surgery, and pharmacology including vaccine strategies. Understanding the molecular events involved in the premalignant to malignant transformation in high-risk individuals may ultimately contribute significantly to novel prevention strategies.
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Affiliation(s)
- Charles M Bowen
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Eduardo Vilar
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Payal D Shah
- Perelman Center for Advanced Medicine, Abramson Cancer Center, Philadelphia, PA
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2
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Correlations between Gut Microbial Composition, Pathophysiological and Surgical Aspects in Endometriosis: A Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020347. [PMID: 36837548 PMCID: PMC9962646 DOI: 10.3390/medicina59020347] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
Background and Objectives: Endometriosis is an estrogen-dependent, inflammatory, gynecological disorder represented by the migration of endometrial tissue outside the uterus. It can manifest through gynecological and gastrointestinal (GI) signs. Given the hormonal imbalances in endometriosis and the effect of microbiota on immune dysfunction, it has been thought that the human microbiome may play a role in its pathogenesis, acting differently before and after laparotomy. The aim of this review is to establish whether there is an interaction between endometriosis and gut microbial composition. Materials and Methods: We aimed to review available literature by systematically searching five databases: PubMed, EMBASE, Scopus, Cochrane Library, and ScienceDirect. We included records describing gut microbiota in the context of endometriosis-observing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines-to recognize the presence of disease by the expression of bacterial taxa-based on 16S ribosomal RNA gene sequencing analysis. Results: Among 10 studies selected, there were four review articles and six clinical trials. The latter identified significant differences at a genus level in increased Prevotella, Blautia, and Bifidobacterium and decreased Paraprevotella, Ruminococcus, and Lachnospira (p < 0.05). In patients undergoing abdominal hysterectomy, Proteobacteria phylum increased from 34.36% before surgery to 54.04% after surgery (p < 0.05). Conclusions: Although scientific literature reports different characterizations of intestinal microbiota in endometriotic patients, further evidence is needed to develop new diagnostic-therapeutic strategies, for example, administration with probiotics before surgery.
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Gelderblom ME, IntHout J, Dagovic L, Hermens RPMG, Piek JMJ, de Hullu JA. The effect of opportunistic salpingectomy for primary prevention of ovarian cancer on ovarian reserve: a systematic review and meta-analysis. Maturitas 2022; 166:21-34. [PMID: 36030627 DOI: 10.1016/j.maturitas.2022.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Opportunistic salpingectomy (OS) is an attractive method for primary prevention of ovarian cancer. Although OS has not been associated with a higher complication rate, it may be associated with earlier onset of menopause. OBJECTIVE To provide a systematic review and meta-analysis of the effect of OS on both age at menopause and ovarian reserve. METHODS A search was conducted in the Cochrane Library, Embase and MEDLINE databases from inception until March 2022. We included randomized clinical trials and cohort studies investigating the effect of OS on onset of menopause and/or ovarian reserve through change in anti-Müllerian hormone (AMH), antral follicle count (AFC), estradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH). Data was extracted independently by two researchers. Random-effects meta-analyses were conducted to estimate the pooled effect of OS on ovarian reserve. RESULTS The initial search yielded 1047 studies. No studies were found investigating the effect of OS on age of menopause. Fifteen studies were included in the meta-analysis on ovarian reserve. Meta-analyses did not result in statistically significant differences in mean change in AMH (MD -0.07 ng/ml, 95%CI -0.18;0.05), AFC (MD 0.20 n, 95 % CI -4.91;5.30), E2 (MD 3.97 pg/ml, 95%CI -0.92;8.86), FSH (MD 0.33mIU/ml, 95%CI -0.15;0.81) and LH (MD 0.03mIU/ml; 95%CI -0.47;0.53). CONCLUSION Our study shows that OS does not result in a significant reduction of ovarian reserve in the short term. Further research is essential to confirm the absence of major effects of OS on menopausal onset since clear evidence on this subject is lacking. Registration number PROSPERO CRD42021260966.
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Affiliation(s)
- M E Gelderblom
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - J IntHout
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L Dagovic
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R P M G Hermens
- Radboud Institute for Health Sciences, Department of IQ Health Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J M J Piek
- Department of Obstetrics and Gynecology and Catharina Cancer Institute, Catharina Hospital, Eindhoven, The Netherlands
| | - J A de Hullu
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Clendenen TV, Ge W, Koenig KL, Afanasyeva Y, Agnoli C, Bertone-Johnson E, Brinton LA, Darvishian F, Dorgan JF, Eliassen AH, Falk RT, Hallmans G, Hankinson SE, Hoffman-Bolton J, Key TJ, Krogh V, Nichols HB, Sandler DP, Schoemaker MJ, Sluss PM, Sund M, Swerdlow AJ, Visvanathan K, Liu M, Zeleniuch-Jacquotte A. Breast Cancer Risk Factors and Circulating Anti-Müllerian Hormone Concentration in Healthy Premenopausal Women. J Clin Endocrinol Metab 2021; 106:e4542-e4553. [PMID: 34157104 PMCID: PMC8530718 DOI: 10.1210/clinem/dgab461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT We previously reported that anti-Müllerian hormone (AMH), a marker of ovarian reserve, is positively associated with breast cancer risk, consistent with other studies. OBJECTIVE This study assessed whether risk factors for breast cancer are correlates of AMH concentration. METHODS This cross-sectional study included 3831 healthy premenopausal women (aged 21-57, 87% aged 35-49) from 10 cohort studies among the general population. RESULTS Adjusting for age and cohort, AMH positively associated with age at menarche (P < 0.0001) and parity (P = 0.0008) and inversely associated with hysterectomy/partial oophorectomy (P = 0.0008). Compared with women of normal weight, AMH was lower (relative geometric mean difference 27%, P < 0.0001) among women who were obese. Current oral contraceptive (OC) use and current/former smoking were associated with lower AMH concentration than never use (40% and 12% lower, respectively, P < 0.0001). We observed higher AMH concentrations among women who had had a benign breast biopsy (15% higher, P = 0.03), a surrogate for benign breast disease, an association that has not been reported. In analyses stratified by age (<40 vs ≥40), associations of AMH with body mass index and OCs were similar in younger and older women, while associations with the other factors (menarche, parity, hysterectomy/partial oophorectomy, smoking, and benign breast biopsy) were limited to women ≥40 (P-interaction < 0.05). CONCLUSION This is the largest study of AMH and breast cancer risk factors among women from the general population (not presenting with infertility), and it suggests that most associations are limited to women over 40, who are approaching menopause and whose AMH concentration is declining.
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Affiliation(s)
- Tess V Clendenen
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Wenzhen Ge
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Karen L Koenig
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Yelena Afanasyeva
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Elizabeth Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Farbod Darvishian
- Pathology, New York University School of Medicine, New York, NY, USA
- Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Göran Hallmans
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Susan E Hankinson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Judith Hoffman-Bolton
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina, Chapel Hill; NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Minouk J Schoemaker
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Patrick M Sluss
- Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Malin Sund
- Department of Surgery, Umeå University Hospital, Umeå, Sweden
| | - Anthony J Swerdlow
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- Division of Breast Cancer Research, The Institute of Cancer Research, London, UK
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Mengling Liu
- Department of Population Health, New York University School of Medicine, New York, NY, USA
- Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | - Anne Zeleniuch-Jacquotte
- Department of Population Health, New York University School of Medicine, New York, NY, USA
- Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
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van Lieshout LAM, Piek JMJ, Verwijmeren K, Houterman S, Siebers AG, de Hullu JA, Bekkers RLM. Ovarian cancer risk after salpingectomy for ectopic pregnancy or hydrosalpinx: results of the OCASE nationwide population-based database study. Hum Reprod 2021; 36:211-218. [PMID: 33156914 DOI: 10.1093/humrep/deaa264] [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: 04/15/2020] [Revised: 08/27/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the effect of salpingectomy for ectopic pregnancy or hydrosalpinx at a young age on ovarian cancer risk compared to no salpingectomy for any reason? SUMMARY ANSWER We found no significant reduction in ovarian cancer risk after salpingectomy for ectopic pregnancy or hydrosalpinx. WHAT IS KNOWN ALREADY Salpingectomy may reduce ovarian cancer incidence, although the lag-time between intervention and therapeutic effect remains to be elucidated. STUDY DESIGN, SIZE, DURATION This nationwide population-based database study uses the Dutch pathology database to identify all women who underwent salpingectomy for ectopic pregnancy or hydrosalpinx between January 1990 and December 2012 and compared ovarian cancer incidence to a control group of women who had a benign dermal nevus removed, matched for age at the time and year of procedure. PARTICIPANTS/MATERIALS, SETTING, METHODS After selection and manual control of intervention and control group, ovarian cancer incidence was recorded. Hazard ratios (HRs) with 95% CI for the development of ovarian cancer were calculated with Cox regression analyses, both unadjusted and adjusted for age. Subgroup analyses were performed to investigate lag-time between intervention and protective effect. MAIN RESULTS AND THE ROLE OF CHANCE In all, 18 961 women were included in the intervention group; 17 106 women had a unilateral salpingectomy and 1855 had a bilateral salpingectomy. The control group consisted of 23 686 women. With 14 ovarian cancer cases in the intervention group, the incidence rate (IR) of ovarian cancer was 5.4 (95% CI 3.1-8.9) per 100 000 person-years. In the control group, there were 24 ovarian cancer cases, resulting in an IR of 7.1 (95% CI 4.7-10.5) per 100 000 person-years (P = 0.34). The age-adjusted HR for ovarian cancer was 0.76 (95% CI 0.39-1.47) after salpingectomy. Unilateral salpingectomy resulted in an age-adjusted HR of 0.81 (95% CI 0.41-1.59) and bilateral salpingectomy resulted in an age-adjusted HR of 0.43 (95% CI 0.06-3.16) based on one case. None of our subgroup analysis for lag-time resulted in a significant difference in ovarian cancer incidence between intervention and control group. The difference in ovarian cancer incidence appeared largest in women with at least 8 years of follow-up (P = 0.08). LIMITATIONS, REASONS FOR CAUTION Due to the young population, ovarian cancer incidence is low, even at the end of follow-up. Furthermore, due to the anonymous nature of the pathology registry, we were unable to adjust for confounding factors. WIDER IMPLICATIONS OF THE FINDINGS Although results did not reach statistical significance, they add to the available data on ovarian cancer incidence after salpingectomy. Our subgroup analysis suggests there may be no benefit in the first years following salpingectomy. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
| | | | - K Verwijmeren
- Department of Obstetrics and Gynaecology, Catharina Cancer Institute, Catharina Hospital, Eindhoven 5623EJ, The Netherlands.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht 6200MD, The Netherlands
| | - S Houterman
- Department of Education and Research, Catharina Hospital, Eindhoven 5623EJ, The Netherlands
| | - A G Siebers
- PALGA, Houten 3991SZ, The Netherlands.,Department of Pathology, Radboud University Medical Center, Nijmegen 6525GA, The Netherlands
| | - J A de Hullu
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen 6525GA, The Netherlands
| | - R L M Bekkers
- Department of Obstetrics and Gynaecology, Catharina Cancer Institute, Catharina Hospital, Eindhoven 5623EJ, The Netherlands.,GROW school for Oncology and Developmental Biology, Maastricht University, Maastricht 6229ER, The Netherlands
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The effect of bilateral tubal ligation on menopause age and symptoms. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.899875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Suneja A, Garg A, Bhatt S, Guleria K, Madhu SV, Sharma R. Impact of Opportunistic Salpingectomy on Ovarian Reserve and Vascularity in Patients Undergoing Hysterectomy. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00455-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Boerner T, Long Roche K. Salpingectomy for the Risk Reduction of Ovarian Cancer: Is It Time for a Salpingectomy-alone Approach? J Minim Invasive Gynecol 2020; 28:403-408. [PMID: 33038519 DOI: 10.1016/j.jmig.2020.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/28/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To summarize published evidence supporting current strategies for the prevention of epithelial ovarian cancer in women with a genetic, elevated risk for the development of this disease, as well as the emerging data on the novel salpingectomy with delayed oophorectomy (SDO) strategy. Furthermore, we will explore whether salpingectomy alone is a viable risk-reducing strategy for these women. We will also discuss current national guidelines for risk-reducing surgery based on patients' individual genetic predisposition. DATA SOURCES MEDLINE, PubMed, EMBASE, and the Cochrane Database, with a focus on randomized controlled trials and large prospective, observational studies. METHODS OF STUDY SELECTION The key search terms for our review included Medical Subject Headings: "salpingectomy," "ovarian cancer," and "risk-reducing surgery." TABULATION, INTEGRATION, AND RESULTS The fallopian tube is now well established as the site of origin for most ovarian cancers, particularly high-grade serous carcinomas. This finding has led to the development of new preventive surgical techniques, such as SDO, which may be associated with fewer side effects. However, until the results of ongoing trials are reported and the impact of SDO on ovarian cancer risk reduction is established, it should not be recommended outside of clinical trials, and bilateral salpingo-oophorectomy remains the treatment of choice for risk-reducing surgery, especially in women with a genetic, high risk for ovarian cancer. CONCLUSION The decision to undergo risk-reducing surgery among women with an elevated risk for ovarian cancer should be made after comprehensive consultation and individually based on genetic predisposition, childbearing status, and personal preference.
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Affiliation(s)
- Thomas Boerner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (all authors); Department of Obstetrics and Gynecology, Weill Cornell Medical College (Dr. Long Roche), New York, New York
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (all authors); Department of Obstetrics and Gynecology, Weill Cornell Medical College (Dr. Long Roche), New York, New York.
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Comparative Study of Ovarian Function in Patients Undergoing Hysterectomy With or Without Bilateral Complete Salpingectomy. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Ovarian cancer is a common gynecologic malignancy with a poor prognosis and a lack of screening for women at average risk. Focus has therefore shifted toward strategies for risk-reducing surgery to prevent the development of ovarian cancer. This Practice Pearl describes the evidence supporting opportunistic salpingectomy at the time of hysterectomy or tubal sterilization as a strategy to reduce the risk of ovarian cancer, the risks and benefits associated with the procedure, and the methods used.
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ATILGAN R, PALA Ş, KULOĞLU T, ŞANLI C, YAVUZKIR Ş, ÖZKAN ZS. Comparison of the efficacy between bilateral proximal tubal occlusion and total salpingectomy on ovarian reserve and the cholinergic system: an experimental study. Turk J Med Sci 2020; 50:1097-1105. [PMID: 32394684 PMCID: PMC7379445 DOI: 10.3906/sag-2002-179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/10/2020] [Indexed: 01/11/2023] Open
Abstract
Background and aim To compare the effects of bilateral proximal tubal occlusion and bilateral total salpingectomy on ovarian reserve and the cholinergic system via rat experiment. Materials and methods Twenty-one adult female rats were randomly divided into the following three groups:G1 (n = 7), sham group;G2 (n = 7), bilateral total salpingectomy group; and G3 (n = 7), bilateral proximal tubal occlusion group. Four weeks later, the abdomen of the rats was opened. The right ovarian tissues were stored in 10% formaldehyde, whereas the left ovarian tissues were stored at –80 °C in aluminum foil. Serum samples were evaluated for antimullerian hormone. The right ovary was used for histological and immunoreactive examination, and the left ovary was used for tissue MDA analysis. Tissue samples were analyzed for MDA levels with spectrophotometric measurement, apoptosis with TUNEL staining, fibrosis score with Mason trichrome staining, ovarian reserve with HE staining, and cholinergic receptor muscarinic 1 (CHRM1) level with immunoreactivity method. Results Compared to G1 and G3, the number of corpus luteum with secondary follicles was significantly lower in G2, whereas the number of ovarian cysts and fibrosis and apoptosis scores increased significantly. The CHRM1 immunoreactivity was significantly lower in G2 than in G1 and G3. Conclusions Compared to the bilateral proximal tubal occlusion performed by using bipolar cautery, bilateral total salpingectomy in rats leads to a significant damage in ovarian histopathology and the cholinergic system.
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Affiliation(s)
- Remzi ATILGAN
- Department of Obstetrics and Gynecology, School of Medicine, Fırat University, ElazığTurkey
| | - Şehmus PALA
- Department of Obstetrics and Gynecology, School of Medicine, Fırat University, ElazığTurkey
| | - Tuncay KULOĞLU
- Department of Histology and Embryology, School of Medicine, Fırat University, ElazığTurkey
| | - Cengiz ŞANLI
- Department of Obstetrics and Gynecology, School of Medicine, Fırat University, ElazığTurkey
| | - Şeyda YAVUZKIR
- Department of Obstetrics and Gynecology, School of Medicine, Fırat University, ElazığTurkey
| | - Zehra Sema ÖZKAN
- Department of Obstetrics and Gynecology, School of Medicine, Kırıkkale University, KırıkkaleTurkey
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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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High-throughput sequencing study of the effect of transabdominal hysterectomy on intestinal flora in patients with uterine fibroids. BMC Microbiol 2020; 20:98. [PMID: 32299359 PMCID: PMC7161020 DOI: 10.1186/s12866-020-01779-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/02/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To investigate the effect of transabdominal hysterectomy on the diversity of the intestinal flora in patients with uterine fibroids. Patients with uterine fibroids were selected from September 2018 to December 2018, in the Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, and stool specimens were collected from patients before and after surgery. RESULTS High-throughput sequencing of the 16S rRNA gene was used to detect the changes in microbial community structure and diversity, and the effects of total hysterectomy on the intestinal flora were further analyzed. Estrogen levels decreased after trans-abdominal hysterectomy. High-throughput sequencing showed that after abdominal hysterectomy, the abundance and diversity of the intestinal flora decreased. The abundance changes were mainly due to Proteobacteria, where their abundance increased. CONCLUSIONS Trans-abdominal hysterectomy changes the intestinal flora of the body by lowering the level of estrogen in the body, which reduces the diversity and abundance of the intestinal flora.
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Abstract
Ovarian function after hysterectomy is a subject of much controversy since many years. There is increasing awareness among gynecologists that the ovaries need to be spared at hysterectomy for benign conditions. However the awareness is limited, and many practitioners believe in removal of ovaries at hysterectomy. Removal of ovaries will save lives of patients at risk of developing ovarian cancer. But it will be unnecessary for low-risk women and will in fact endanger their lives by increasing cardiac risks. Recent data suggest that ovarian epithelial cancer arises from tubal epithelium, which adds new option of performing only salpingectomy and sparing ovaries, which will serve dual purpose of preventing ovarian cancer and continuing productive function of ovaries. Reproductive function is lost with hysterectomy. But it may be worth looking at impact of hysterectomy on productive function of ovaries. This editorial will focus on this issue and look at evidence on effects of other gynecological procedures on ovarian function.
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Kotsopoulos J, Narod SA. Prophylactic salpingectomy for the prevention of ovarian cancer: Who should we target? Int J Cancer 2020; 147:1245-1251. [PMID: 32037528 DOI: 10.1002/ijc.32916] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/14/2020] [Accepted: 01/31/2020] [Indexed: 12/12/2022]
Abstract
Ovarian cancer is the most fatal gynecologic malignancy (50% 5-year survival) due to a typically advanced stage at diagnosis and a high rate of recurrence. Chemoprevention options are limited, and few interventions have been shown to reduce cancer risk or mortality. Emerging data support the model that fallopian tubes are the site of origin for a proportion of high-grade serous cancers. This implies that a subset of cancers may be prevented by removing the fallopian tubes while leaving the ovaries intact. Accordingly, there has been shift in clinical practice for average risk women; some now recommend removal of both the fallopian tubes only instead of tubal ligation for sterilization or at the time of benign gynecologic surgery. This has been termed opportunistic salpingectomy and represents a means of decreasing the burden of ovarian cancer by preventing cancers that arise in the fallopian tubes. There have been no detailed, prospective reports that have estimated ovarian cancer risk reduction with opportunistic salpingectomy, neither among women at baseline population risk nor among women at a high risk of developing the disease. The situation is complicated for women with a BRCA mutation-bilateral salpingo-oophorectomy is a proven means of risk reduction and salpingectomy alone is not the standard of care. Based on the existing data, salpingectomy alone should only be reserved for women with a lifetime risk of ovarian cancer of less than 5%.
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Affiliation(s)
- Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Vahedpour Z, Abedzadeh-Kalahroudi M, Sehat M, Allamezadeh-Davani S. The effects of salpingectomy on the serum level of anti-Müllerian hormone: A single-blind randomized controlled trial. J Gynecol Obstet Hum Reprod 2019; 49:101658. [PMID: 31786349 DOI: 10.1016/j.jogoh.2019.101658] [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: 09/02/2019] [Revised: 11/09/2019] [Accepted: 11/23/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Concerns exist over the effects of salpingectomy on ovarian function. This study aimed to assess the effects of salpingectomy on the serum level of anti-Müllerian hormone. MATERIALS AND METHODS This single-blind randomized controlled trial was conducted in 2017-2018 on 86 candidates for hysterectomy. Participants were randomly allocated to undergo either hysterectomy without salpingectomy (control group) or hysterectomy with salpingectomy (intervention group). Serum anti-Müllerian hormone level was measured both before and three months after surgery. Data were analyzed through the Mann-Whitney U test, the Chi-square test, the analysis of covariance, and the linear regression analysis. RESULTS The mean value of Serum anti-Müllerian hormone level did not significantly change in the study groups (P>0.05). After removing the effects of confounders, study groups did not significantly differ from each other respecting the posttest mean value of serum anti-Müllerian hormone level (P=0.868). CONCLUSION Salpingectomy does not significantly affect serum anti-Müllerian hormone level and ovarian function.
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Affiliation(s)
- Zahra Vahedpour
- Autoimmune Research Center, Kashan University of Medical Sciences, Kashan, Iran.
| | | | - Mojtaba Sehat
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran.
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van Lieshout LAM, Steenbeek MP, De Hullu JA, Vos MC, Houterman S, Wilkinson J, Piek JMJ. Hysterectomy with opportunistic salpingectomy versus hysterectomy alone. Cochrane Database Syst Rev 2019; 8:CD012858. [PMID: 31456223 PMCID: PMC6712369 DOI: 10.1002/14651858.cd012858.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Ovarian cancer has the highest mortality rate of all gynaecological malignancies with an overall five-year survival rate of 30% to 40%. In the past two decades it has become apparent and more commonly accepted that a majority of ovarian cancers originate in the fallopian tube epithelium and not from the ovary itself. This paradigm shift introduced new possibilities for ovarian cancer prevention. Salpingectomy during a hysterectomy for benign gynaecological indications (also known as opportunistic salpingectomy) might reduce the overall incidence of ovarian cancer. Aside from efficacy, safety is of utmost importance, especially due to the preventive nature of opportunistic salpingectomy. Most important are safety in the form of surgical adverse events and postoperative hormonal status. Therefore, we compared the benefits and risks of hysterectomy with opportunistic salpingectomy to hysterectomy without opportunistic salpingectomy. OBJECTIVES To assess the effect and safety of hysterectomy with opportunistic salpingectomy versus hysterectomy without salpingectomy for ovarian cancer prevention in women undergoing hysterectomy for benign gynaecological indications; outcomes of interest include the incidence of epithelial ovarian cancer, surgery-related adverse events and postoperative ovarian reserve. SEARCH METHODS The Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two clinical trial registers were searched in January 2019 together with reference checking and contact with study authors. SELECTION CRITERIA We intended to include both randomised controlled trials (RCTs) and non-RCTs that compared ovarian cancer incidence after hysterectomy with opportunistic salpingectomy to hysterectomy without opportunistic salpingectomy in women undergoing hysterectomy for benign gynaecological indications. For assessment of surgical and hormonal safety, we included RCTs that compared hysterectomy with opportunistic salpingectomy to hysterectomy without opportunistic salpingectomy in women undergoing hysterectomy for benign gynaecological indications. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The primary review outcomes were ovarian cancer incidence, intraoperative and short-term postoperative complication rate and postoperative hormonal status. Secondary outcomes were total surgical time, estimated blood loss, conversion rate to open surgery (applicable only to laparoscopic and vaginal approaches), duration of hospital admission, menopause-related symptoms and quality of life. MAIN RESULTS We included seven RCTs (350 women analysed). The evidence was of very low to low quality: the main limitations being a low number of included women and surgery-related adverse events, substantial loss to follow-up and a large variety in outcome measures and timing of measurements.No studies reported ovarian cancer incidence after hysterectomy with opportunistic salpingectomy compared to hysterectomy without opportunistic salpingectomy in women undergoing hysterectomy for benign gynaecological indications. For surgery-related adverse events, there were insufficient data to assess whether there was any difference in both intraoperative (odds ratio (OR) 0.66, 95% confidence interval (CI) 0.11 to 3.94; 5 studies, 286 participants; very low-quality evidence) and short-term postoperative (OR 0.13, 95% CI 0.01 to 2.14; 3 studies, 152 participants; very low-quality evidence) complication rates between hysterectomy with opportunistic salpingectomy and hysterectomy without opportunistic salpingectomy because the number of surgery-related adverse events was very low. For postoperative hormonal status, the results were compatible with no difference, or with a reduction in anti-Müllerian hormone (AMH) that would not be clinically relevant (mean difference (MD) -0.94, 95% CI -1.89 to 0.01; I2 = 0%; 5 studies, 283 participants; low-quality evidence). A reduction in AMH would be unfavourable, but due to wide CIs, the postoperative change in AMH can still vary from a substantial decrease to even a slight increase. AUTHORS' CONCLUSIONS There were no eligible studies reporting on one of our primary outcomes - the incidence of ovarian cancer specifically after hysterectomy with or without opportunistic salpingectomy. However, outside the scope of this review there is a growing body of evidence for the effectiveness of opportunistic salpingectomy itself during other interventions or as a sterilisation technique, strongly suggesting a protective effect. In our meta-analyses, we found insufficient data to assess whether there was any difference in surgical adverse events, with a very low number of events in women undergoing hysterectomy with and without opportunistic salpingectomy. For postoperative hormonal status we found no evidence of a difference between the groups. The maximum difference in time to menopause, calculated from the lower limit of the 95% CI and the natural average AMH decline, would be approximately 20 months, which we consider to be not clinically relevant. However, the results should be interpreted with caution and even more so in very young women for whom a difference in postoperative hormonal status is potentially more clinically relevant. Therefore, there is a need for research on the long-term effects of opportunistic salpingectomy during hysterectomy, particularly in younger women, as results are currently limited to six months postoperatively. This limit is especially important as AMH, the most frequently used marker for ovarian reserve, recovers over the course of several months following an initial sharp decline after surgery. In light of the available evidence, addition of opportunistic salpingectomy should be discussed with each woman undergoing a hysterectomy for benign indication, with provision of a clear overview of benefits and risks.
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Affiliation(s)
- Laura A M van Lieshout
- Catharina Cancer Institute, Catharina HospitalDepartment of Obstetrics and GynaecologyMichelangelolaan 2EindhovenNetherlands5623EJ
- Radboud University Nijmegen Medical CentreDepartment of Obstetrics and GynaecologyNijmegenNijmegenNetherlands6525 GA
| | - Miranda P Steenbeek
- Radboud University Nijmegen Medical CentreDepartment of Obstetrics and GynaecologyNijmegenNijmegenNetherlands6525 GA
| | - Joanne A De Hullu
- Radboud University Nijmegen Medical CentreDepartment of Obstetrics and GynaecologyNijmegenNijmegenNetherlands6525 GA
| | - M Caroline Vos
- Elisabeth‐TweeSteden HospitalObstetrics and GynaecologyHilvarenbeekseweg 60TilburgNetherlands5000LC
| | - Saskia Houterman
- Catharina HospitalDepartment of Education and ResearchMichelangelolaan 2EindhovenNetherlands5623 EJ
| | - Jack Wilkinson
- Manchester Academic Health Science Centre (MAHSC), University of ManchesterCentre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and HealthClinical Sciences Building Salford Royal NHS Foundation Trust HospitalRoom 1.315, Jean McFarlane Building University Place Oxford RoadManchesterUKM13 9PL
| | - Jurgen MJ Piek
- Catharina Cancer Institute, Catharina HospitalDepartment of Obstetrics and GynaecologyMichelangelolaan 2EindhovenNetherlands5623EJ
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Tamhane N, Imudia AN, Mikhail E. Contemporary management of adnexa at the time of benign hysterectomy: a review of the literature. J OBSTET GYNAECOL 2019; 39:896-902. [PMID: 31303119 DOI: 10.1080/01443615.2019.1581747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ovarian cancer is the leading cause of Gynecological cancer related mortality in the USA. Due to the absence of an effective screening method, concomitant adnexal management during hysterectomy or other pelvic surgeries is a prime consideration. Bilateral salpingo-oophorectomy (BSO) offers the benefit of eliminating the risk of ovarian cancer however it leads to surgical menopause with unfavourable overall health outcomes. With the latest verification that serous tubal intraepithelial carcinoma detected in the distal fimbriated end of the fallopian tube being the precursor of Type 2 ovarian cancers, there is an increased trend of performing bilateral salpingectomy (BS) as a risk reduction strategy for ovarian cancer. Women with a high risk for ovarian cancer due to familial or genetic mutations and those diagnosed with endometriosis need particular attention while planning adnexal management during hysterectomy. Physician and patient's shared decision-making regarding adnexal management during benign hysterectomy taking into consideration the route of hysterectomy is an important portion of pre-operative planning. The objective of this article is to understand the current trends of BSO and BS during benign hysterectomy and appreciate the pros and cons to aid in pre-operative counselling of patients.
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Affiliation(s)
- Nupur Tamhane
- Department of Obstetrics & Gynecology, Morsani College School of medicine, University of South Florida , Tampa , FL , USA
| | - Anthony N Imudia
- Department of Obstetrics & Gynecology, Morsani College School of medicine, University of South Florida , Tampa , FL , USA
| | - Emad Mikhail
- Department of Obstetrics & Gynecology, Morsani College School of medicine, University of South Florida , Tampa , FL , USA
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19
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Yuan Z, Cao D, Bi X, Yu M, Yang J, Shen K. The effects of hysterectomy with bilateral salpingectomy on ovarian reserve. Int J Gynaecol Obstet 2019; 145:233-238. [PMID: 30805925 DOI: 10.1002/ijgo.12798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/02/2018] [Accepted: 02/22/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine whether ovarian reserve is compromised after hysterectomy with bilateral salpingectomy. METHODS A prospective longitudinal study was conducted among 84 women who underwent hysterectomy with bilateral salpingectomy at a tertiary medical center in Beijing, China, between August 2, 2015, and January 15, 2017. Serum levels of anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) were measured to assess ovarian function before undergoing the procedure (baseline) and at weeks 1 and 6 after surgery (postoperative period). RESULTS The median age was 41.61 ± 0.62 years. Age negatively correlated with the serum AMH level at baseline (P<0.001), as well as with preoperative-to-postoperative changes in the concentration of this hormone (P<0.001). Serum AMH levels were lower in the postoperative period versus the preoperative period (P<0.001). By contrast, serum FSH levels were higher in the postoperative period than in the preoperative period (P<0.001). Moreover, no correlation was found with body mass index. CONCLUSIONS Hysterectomy with bilateral salpingectomy compromised ovarian reserve, with the damage being most severe among younger patients.
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Affiliation(s)
- Zhen Yuan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoning Bi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Mei Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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20
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Collins E, Strandell A, Granåsen G, Idahl A. Menopausal symptoms and surgical complications after opportunistic bilateral salpingectomy, a register-based cohort study. Am J Obstet Gynecol 2019; 220:85.e1-85.e10. [PMID: 30321526 DOI: 10.1016/j.ajog.2018.10.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/26/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND In recent years, the fallopian tubes have been found to play a critical role in the pathogenesis of ovarian cancer. Therefore, bilateral salpingectomy at the time of hysterectomy has been proposed as a preventive procedure, but with scarce scientific evidence to support the efficiency and safety. OBJECTIVE Our primary objective was to evaluate the risk of surgical complications and menopausal symptoms when performing bilateral salpingectomy in addition to benign hysterectomy. Furthermore, we sought to compare time in surgery, perioperative blood loss/blood transfusion, duration of hospital stay, days to normal activities of daily living, and days out of work for hysterectomy with bilateral salpingectomy compared with hysterectomy only. A secondary objective was to study the uptake of opportunistic salpingectomy in Sweden. STUDY DESIGN This was a retrospective observational cohort study based on data from the National Quality Register of Gynecological Surgery in Sweden. Women <55 years of age who had a hysterectomy for benign indications with or without bilateral salpingectomy in 1998 through 2016 were included. Possible confounding was adjusted for in multivariable regression models. RESULTS During the study period, 23,369 women had a hysterectomy for benign indications. The frequency of bilateral salpingectomy at the time of hysterectomy increased mainly from 2013, which is why the period 2013 through mid-2016 was selected for further analysis (n = 6892). There was a low frequency of vaginal hysterectomy with bilateral salpingectomy performed in this period, which is why only abdominal and laparoscopic surgeries were selected for comparative analysis (n = 4906). This study indicates an increased risk of menopausal symptoms (adjusted relative risk, 1.33; 95% confidence interval, 1.04-1.69) 1 year after hysterectomy with bilateral salpingectomy compared with hysterectomy only. Hospital stay was 0.1 days longer in women having salpingectomy (P = .01), and bleeding was slightly reduced in the salpingectomy group (-20 mL, P = .04). Other outcome measures were not significantly associated with salpingectomy, albeit a tendency toward higher risk of minor complications was seen (adjusted relative risk, 1.30; 95% confidence interval, 0.93-1.83). CONCLUSION Bilateral salpingectomy at the time of hysterectomy was associated with an increased risk of menopausal symptoms 1 year after surgery. Randomized clinical trials reducing the risk of residual and unmeasured confounding and longer follow-up are needed to correctly inform women on the risks and benefits of opportunistic salpingectomy.
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21
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Clark NV, Endicott SP, Jorgensen EM, Hur HC, Lockrow EG, Kern ME, Jones-Cox CE, Dunlow SG, Einarsson JI, Cohen SL. Review of Sterilization Techniques and Clinical Updates. J Minim Invasive Gynecol 2018; 25:1157-1164. [DOI: 10.1016/j.jmig.2017.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/09/2017] [Accepted: 09/11/2017] [Indexed: 12/19/2022]
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Duncan JR, Jones HL, Hoffer SO, Schenone MH, Mari G. Bilateral salpingectomy versus bilateral partial salpingectomy during cesarean delivery. Int J Womens Health 2018; 10:649-653. [PMID: 30425586 PMCID: PMC6204850 DOI: 10.2147/ijwh.s180329] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To compare surgical outcomes in patients undergoing bilateral salpingectomy (salpingectomy group) with those who had partial salpingectomy (partial salpingectomy group) during cesarean delivery. Materials and methods A chart review from July 2015 to November 2016 was performed. We included women who had sterilization during cesarean delivery. We excluded sterilization by occlusive methods. Our primary outcomes were total operative time and a composite score of transfusion rate, internal organ injury, hospital readmission, and endometritis. Secondary outcomes included menstrual abnormalities, pelvic pain, quality of life assessment, and regrets rate. We compared these outcomes between women in the salpingectomy and partial salpingectomy groups. Chi-squared, Fisher’s exact, t-test, and Mann–Whitney U were utilized for statistical analysis where appropriate. A P<0.05 was considered significant. Results We included a total of 160 pregnancies. Of these, 41 were in the salpingectomy and 119 in the partial salpingectomy group. The median total operative time was longer for the salpingectomy group (62 [IQR 54, 71] vs 60 minutes [IQR 46, 72]; P=0.03). The composite of surgical complications (19.5% vs 12.6%; P=0.28) was not significantly different between our study groups. Menstrual irregularities (P≥0.99), quality of life (P≥0.99), dyspareunia (P≥0.99), dysmenorrhea (P=0.36), and regrets (P≥0.99) were not different between groups. Conclusion Salpingectomy during cesarean delivery increased the median operative time by 2 minutes and may not be associated with an increased risk of surgical complications. We acknowledge the need for larger multi-center trials to corroborate our outcomes.
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Affiliation(s)
- Jose R Duncan
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA, .,Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA,
| | - Heather L Jones
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA,
| | - Stefanie O Hoffer
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA,
| | - Mauro H Schenone
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA,
| | - Giancarlo Mari
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA,
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Mothes AR, Schlachetzki A, Nicolaus K, Vorwergk J, Lehmann T, Radosa MP, Mothes HK, Runnebaum IB. LAVH superior to TVH when concomitant salpingo-oophorectomy is intended in prolapse hysterectomy: a comparative cohort study. Arch Gynecol Obstet 2018; 298:1131-1137. [PMID: 30306309 DOI: 10.1007/s00404-018-4909-z] [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: 02/04/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE This comparative cohort study evaluated the influence of surgical route for prolapse hysterectomy (vaginal or laparoscopically assisted) on the achievement of intended elective salpingo-oophorectomy, which was a procedural goal planned with the patient before primary vaginal native-tissue prolapse surgery. METHODS Consecutive patients who underwent total vaginal hysterectomy (TVH; n = 163) or laparoscopically assisted vaginal hysterectomy (LAVH; n = 144) and vaginal native-tissue repair for pelvic organ prolapse at Jena University Hospital were enrolled. RESULTS Peri- and postoperative parameters, including Clavien-Dindo (CD) classification of surgical complications, were compared between groups using Student's t test, Fisher's exact test, and multivariable regression. Patient characteristics were similar, except that grade IV prolapse was more common in the LAVH group (p < 0.001). The following parameters differed between the TVH and LAVH groups: concomitant salpingectomy (1.2% vs. 34%) and salpingo-oophorectomy (45% vs. 66%), non-performance of intended salpingo-oophorectomy (36% vs. 0% OR 0.006, 95% CI < 0.001-0.083), adhesiolysis (0% vs. 44%), CD II-III complications (51% vs. 14.6% p < 0.001), operating time (153 ± 61 vs. 142 ± 27 min), and postoperative in-patient days (9.02 ± 4.9 vs. 4.99 ± 0.96; all p < 0.001). CONCLUSIONS LAVH enabled the safe performance of planned concomitant salpingo-oophorectomy in all cases. To achieve the procedural goal in such cases, laparoscopic assistance in prolapse hysterectomy should be considered.
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Affiliation(s)
- Anke R Mothes
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Anja Schlachetzki
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Kristin Nicolaus
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Julia Vorwergk
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Informatics and Documentation, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Marc P Radosa
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Henning K Mothes
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Ingo B Runnebaum
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
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Grynnerup AGA, Lindhard A, Sørensen S, Ørskov M, Petersen KR, Madsen LB, Pilsgaard F, Løssl K, Pinborg A. Serum anti-Müllerian hormone concentration before and after salpingectomy for ectopic pregnancy. Reprod Biomed Online 2018; 37:624-630. [PMID: 30287173 DOI: 10.1016/j.rbmo.2018.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 12/01/2022]
Abstract
RESEARCH QUESTION Does salpingectomy for ectopic pregnancy affect the ovarian reserve measured by changes in pre- and post-operative levels of anti-Müllerian hormone (AMH)? DESIGN This is a prospective observational multicentre study of 64 women treated with salpingectomy for an ectopic pregnancy. AMH was measured in serum samples collected at admission before salpingectomy and at follow-up (median time to follow-up [interquartile range] was 3 [3-4] months). Changes in serum AMH levels were investigated using Wilcoxon signed-rank test and the relationship between changes in AMH and age, time to follow-up, and pre-operative serum AMH level was investigated using linear regression analysis. The biological variation of AMH was also calculated. RESULTS Serum AMH levels did not differ significantly before and after salpingectomy (median ∆AMH [follow-up value minus admission value] 0.40 pmol/l, interquartile range -2.0 to 4.0 pmol/l). ΔAMH was independent of age, time to follow-up and pre-operative serum AMH level. The intra-individual biological variation for AMH ranged from 12.1% to 26.3%, depending on time between the two samples. CONCLUSIONS This is the first paired study to investigate serum AMH values before and after salpingectomy in an unselected population of women presenting with an ectopic pregnancy, including both patients who conceived naturally and following fertility treatment. It was found that salpingectomy for ectopic pregnancy had no short-term effect on serum AMH levels, and changes in AMH levels were independent of age, time to follow-up, and pre-operative serum AMH level. Furthermore, the study demonstrated a 6-month biological variation of AMH of less than 30%.
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Affiliation(s)
- Anna Garcia-Alix Grynnerup
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark.
| | - Anette Lindhard
- Department of Obstetrics and Gynaecology, Zealand University Hospital Roskilde, Sygehusvej 10, DK-4000 Roskilde, Denmark
| | - Steen Sørensen
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark; Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, Hvidovre DK-2650, Denmark
| | - Mette Ørskov
- Department of Obstetrics and Gynaecology, Odense University Hospital, J. B. Winsløwsvej 4, Odense C Denmark, C DK-5000
| | - Kresten Rubeck Petersen
- Department of Obstetrics and Gynaecology, Odense University Hospital, J. B. Winsløwsvej 4, Odense C Denmark, C DK-5000
| | - Lisbeth Buss Madsen
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - Fie Pilsgaard
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - Kristine Løssl
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - Anja Pinborg
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
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Kim M, Kim YH, Kim YB, Kim J, Kim JW, Park MH, Park JH, Rhee JH, Lim MC, Hong JS. Bilateral salpingectomy to reduce the risk of ovarian/fallopian/peritoneal cancer in women at average risk: a position statement of the Korean Society of Obstetrics and Gynecology (KSOG). Obstet Gynecol Sci 2018; 61:542-552. [PMID: 30254990 PMCID: PMC6137013 DOI: 10.5468/ogs.2018.61.5.542] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 11/09/2022] Open
Abstract
Based on the current understanding of a preventive effect of bilateral salpingectomy on ovarian/fallopian/peritoneal cancers, the Korean Society of Obstetrics and Gynecology, Korean Society of Gynecologic Endocrinology, Korean Society of Gynecologic Oncology, Korean Society of Maternal Fetal Medicine, and Korean Society for Reproductive Medicine support the following recommendations: • Women scheduled for hysterectomy for benign gynecologic disease should be informed that bilateral salpingectomy reduces the risk of ovarian/fallopian/peritoneal cancer, and they should be counseled regarding this procedure at the time of hysterectomy. • Although salpingectomy is generally considered as a safe procedure in terms of preserving ovarian reserve, there is a lack of evidences representing its long-term outcomes. Therefore, patients should be informed about the minimal potential of this procedure for decreasing ovarian reserve. • Prophylactic salpingectomy during vaginal hysterectomy is favorable in terms of prevention of ovarian/fallopian/peritoneal cancer, although operation-related complications minimally increase with this procedure, compared to the complications associated with vaginal hysterectomy alone. Conversion to open or laparoscopic approach from vaginal approach to perform prophylactic salpingectomy is not recommended. • Women who desire permanent sterilization at the time of cesarean delivery could be counseled for prophylactic salpingectomy before surgery on an individual basis.
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Affiliation(s)
- Miseon Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Young-Han Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jayeon Kim
- Department of Obstetrics and Gynecology, CHA Seoul Fertility Center, CHA University School of Medicine, Seoul, Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Mi Hye Park
- Department of Obstetrics and Gynecology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Joo Hyun Park
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Ho Rhee
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, Korea
| | - Myong Cheol Lim
- Cancer Healthcare Research Branch and Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Joon-Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
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Steenbeek MP, van Lieshout LAM, Aarts JWM, Piek JMJ, Coppus SFPJ, Massuger LFAG, Hermens RPMG, de Hullu JA. Factors influencing decision-making around opportunistic salpingectomy: a nationwide survey. J Gynecol Oncol 2018; 30:e2. [PMID: 30479086 PMCID: PMC6304401 DOI: 10.3802/jgo.2019.30.e2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 12/28/2022] Open
Abstract
Objective To explore current practice and influencing factors on adoption of the opportunistic salpingectomy (OS), particularly regarding the decision making, to eventually enhance the development and implementation of clear guidelines. Methods This nationwide cross-sectional survey study was conducted in all hospitals in the Netherlands. An anonymous online survey was sent to gynecologists with special interest in gynecological oncology, gynecological endoscopy or urogynecology and all Dutch gynecology trainees. The survey mainly focused on current practice regarding OS and identification of influencing factors on the level of innovation, organization, healthcare professional and individual patient. Results The response rate was 348 out of 597 gynecologists (58.3%) and 142 out of 340 trainees (41.8%). Current practice of discussing and performing the OS varied widely, with ovarian cancer (OC) risk reduction as most important supportive factor on innovation level. Supportive factors on the level of organization and healthcare provider were; working in a non-training hospital, knowledge of current literature and extensive work experience (in years and annual number of hysterectomies). On individual patient level, a vaginal approach of hysterectomy, negative family history for OC and the presence of firm adhesions were suppressive factors for the OS. Conclusion In this study we evaluated the current practice regarding the opportunistic salpingectomy in the Netherlands and identified influencing factors on different levels to raise awareness and attribute to development of a targeted implementation strategy, on both national and international level.
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Affiliation(s)
- Miranda P Steenbeek
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Laura A M van Lieshout
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Johanna W M Aarts
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen M J Piek
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Sjors F P J Coppus
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.,Máxima Medical Centre, Veldhoven, The Netherlands
| | - Leon F A G Massuger
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joanne A de Hullu
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
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Klotz DM, Wimberger P. Cells of origin of ovarian cancer: ovarian surface epithelium or fallopian tube? Arch Gynecol Obstet 2017; 296:1055-1062. [PMID: 28940023 DOI: 10.1007/s00404-017-4529-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/12/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Ovarian cancer is the fifth most common cancer in women and one of the leading causes of death from gynecological malignancies. Despite of its clinical importance, ovarian tumorigenesis is poorly understood and prognosis remains poor. This is particularly true for the most common type of ovarian cancer, high-grade serous ovarian cancer. RESULTS Two models are considered, whether it arises from the ovarian surface epithelium or from the fallopian tube. The first model is based on (1) the pro-inflammatory environment caused by ovulation events, (2) the expression pattern of ovarian inclusion cysts, and (3) biomarkers that are shared by the ovarian surface epithelium and malignant growth. The model suggesting a non-ovarian origin is based on (1) tubal precursor lesions, (2) genetic evidence of BRCA1/2 mutation carriers, and (3) recent animal studies. Neither model has clearly demonstrated superiority over the other. Therefore, one can speculate that high-grade serous ovarian cancer may arise from two different sites that undergo similar changes. Both tissues are derived from the same embryologic origin, which may explain how progenitor cells from different sites can respond similar to stimuli within the ovaries. However, distinct molecular drivers, such as BRCA deficiency, may still preferentially arise from one site of origin as precancerous mutations are frequently seen in the fallopian tube. CONCLUSIONS Confirming the origin of ovarian cancer has important clinical implications when deciding on cancer risk-reducing prophylactic surgery. It will be important to identify key biomarker to uncover the sequence of ovarian tumorigenesis.
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Affiliation(s)
- Daniel Martin Klotz
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. .,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany.
| | - Pauline Wimberger
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
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Lamblin G, Thiberville G, Bansac Lamblin A, Moret S, Du-Mesnildot P, Rannou C, Ploton I, Chabert P, Chene G. [What haemostatic technique should we use for opportunistic salpingectomy during benign laparoscopic hysterectomy?]. ACTA ACUST UNITED AC 2017; 45:453-459. [PMID: 28757104 DOI: 10.1016/j.gofs.2017.06.017] [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: 04/28/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare ovarian function before and after laparoscopic hysterectomy with bilateral salpingectomy for benign lesions with two different systems of haemostasis. METHODS In this prospective randomized study comparing two types of energy used for coagulation in bilateral salpingectomy (group A: bipolar electric energy, versus group B: ultrasonic advanced energy [Harmonic®]), forty consecutive non-menopausal patients undergoing laparoscopic hysterectomy for benign lesions were included. Values of anti-Müllerian hormone (AMH), LH and FSH, antral follicle count (AFC) and ovarian vascularization on bilateral Doppler ultrasound, quality of life (questionnaire) were assessed preoperatively and at 1 and 3 months postoperatively. RESULTS Preliminary analysis showed shorter salpingectomy operating time (P<0.0001) and less bleeding (P<0.005) in group B. In group A, there was no statistical difference except a decrease in AFC at 1 and 3 months on the right ovary (P=0.04). In group B, AMH levels were significantly lower postoperatively at 3 months and LH levels were increased at 3 months (respectively P=0.02 et P=0.04). There was no statistical difference in the ultrasonographic data. Quality of life did not significantly differ in both groups. CONCLUSION Preliminary findings showed reduced AMH levels at 3months postoperatively in ultrasonic energy group whereas there was no significative menopausal symptoms. It seems important to continue this study in order to know the real effects of both energy systems on the ovarian function.
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Affiliation(s)
- G Lamblin
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - G Thiberville
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - A Bansac Lamblin
- Département de radiologie, Centre lyonnais imagerie féminine, 69000 Lyon, France
| | - S Moret
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - P Du-Mesnildot
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - C Rannou
- Département de radiologie, groupement hospitalier Est, 69000 Lyon-Bron, France
| | - I Ploton
- Département de biochimie, groupement hospitalier Est, 69000 Lyon-Bron, France
| | - P Chabert
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - G Chene
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France; Université Claude-Bernard Lyon-1, EMR 3738, 69000 Lyon, France.
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Behnamfar F, Jabbari H. Evaluation of ovarian function after hysterectomy with or without salpingectomy: A feasible study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:68. [PMID: 28616055 PMCID: PMC5461581 DOI: 10.4103/jrms.jrms_81_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 02/22/2017] [Accepted: 02/28/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prophylactic salpingectomy for the prevention of ovarian cancer has been recommended strongly. The aim of this study was to compare ovarian function in patients who undergo hysterectomy for benign reasons with or without bilateral salpingectomy. MATERIALS AND METHODS This was a clinical-trial study on patients undergone hysterectomy with/without bilateral salpingectomy in Al-Zahra Hospital, in 2015-2016. Demographic information (age, height, and weight) were recorded. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) were measured in 2-5 days of menstrual cycle before operation. Patients were asked to refer in 6 months for follow-up, including FSH and LH re-measurement and also menopausal status examination. Patients were divided into age groups of 39-45, 46-50, and ≥51 and also groups of body mass index including 18.5-24.9, 25-29.9, and 30-34.9. RESULTS A total of 37 patients divided into two groups, including 22 patients undergone hysterectomy without salpingectomy (H) and 15 undergone hysterectomy with bilateral salpingectomy (H-bS). The mean age (standard deviation) of Group H was 47.77 (3.03) and Group H-bS was 48.47 (2.03) (P > 0.05). Furthermore, the mean level of FSH and LH before surgery was not significantly different (P > 0.05). The mean level of FSH and LH changes was not significant between H and H-bS groups (P = 0.17), (P = 0.16). CONCLUSION Bilateral salpingectomy during hysterectomy did not increase the risk of ovarian dysfunction after 6 months follow-up.
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Affiliation(s)
- Fariba Behnamfar
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hajar Jabbari
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
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Tamussino K. Should national societies recommend opportunistic salpingectomy? J Gynecol Oncol 2017; 28:e53. [PMID: 28541640 PMCID: PMC5447151 DOI: 10.3802/jgo.2017.28.e53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 05/07/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Karl Tamussino
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
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Mohamed AA, Yosef AH, James C, Al-Hussaini TK, Bedaiwy MA, Amer SAKS. Ovarian reserve after salpingectomy: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2017; 96:795-803. [PMID: 28471535 DOI: 10.1111/aogs.13133] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 03/11/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Although there has been a growing concern over the possible damaging effect of salpingectomy on ovarian reserve, this issue remains uncertain. The purpose of this meta-analysis was to test the hypothesis that salpingectomy may compromise ovarian reserve. MATERIAL AND METHODS A detailed search was conducted using MEDLINE, Embase, Dynamed Plus, ScienceDirect, TRIP database and the Cochrane Library from January 2000 to November 2016. All cohort, cross-sectional and randomized controlled studies investigating changes in circulating anti-Müllerian hormone (AMH) after salpingectomy were considered. Thirty-seven studies were identified, of which eight were eligible. Data were extracted and entered into RevMan software for calculation of the weighted mean difference (WMD) and 95% CI. Two groups of studies were analyzed separately: group 1 (six studies, n = 464) comparing data before and after salpingectomy and group 2 (two studies) comparing data in women who have undergone salpingectomy (n = 169) vs. healthy controls (n = 154). RESULTS Pooled results of group 1 studies showed no statistically significant change in serum AMH concentration after salpingectomy (WMD, -0.10 ng/mL; 95% CI -0.19 to 0.00, I2 = 0%). Similarly, meta-analysis of group 2 showed no statistically significant difference in serum AMH concentration between salpingectomy group and controls (WMD, -0.11 ng/mL; 95% CI -0.37 to 0.14, I2 = 77%). Subgroup analyses based on laterality of surgery, type of AMH kit and participants' age (<40 years) still showed no statistically significant changes in circulating AMH. CONCLUSION Salpingectomy does not seem to compromise ovarian reserve in the short-term. However, the long-term effect of salpingectomy on ovarian reserve remains uncertain.
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Affiliation(s)
- Ahmed Aboelfadle Mohamed
- Department of Obstetrics and Gynecology, University of Nottingham, Royal Derby Hospital, Derby, UK.,Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
| | - Ali Haroun Yosef
- Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt.,Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, BC, Canada
| | - Cathryn James
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | | | - Mohamed Ali Bedaiwy
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, BC, Canada
| | - Saad Ali K S Amer
- Department of Obstetrics and Gynecology, University of Nottingham, Royal Derby Hospital, Derby, UK
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The Effect of Salpingectomy on Ovarian Function. J Minim Invasive Gynecol 2017; 24:563-578. [DOI: 10.1016/j.jmig.2017.02.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 11/19/2022]
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Long Roche KC, Abu-Rustum NR, Nourmoussavi M, Zivanovic O. Risk-reducing salpingectomy: Let us be opportunistic. Cancer 2017; 123:1714-1720. [PMID: 28334425 DOI: 10.1002/cncr.30528] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/13/2016] [Accepted: 10/13/2016] [Indexed: 12/13/2022]
Abstract
Because there is no screening test for ovarian cancer, effective prevention strategies may be the best way to reduce the mortality of this most lethal gynecologic malignancy. Increasing evidence supports the hypothesis that the fallopian tube is the site of origin for the vast majority of high-grade serous carcinomas. Our growing understanding of the pathogenesis of this disease offers a rare opportunity to explore new preventive measures, such as bilateral salpingectomy, which may provide great benefit without compromising ovarian function. If the tubal paradigm is accurate, then the impact of bilateral salpingectomy could extend to BRCA1 and BRCA2 mutation carriers, high-risk noncarriers, and average-risk women. The authors present a review of the literature on the role of risk-reducing salpingectomy in all women and in high-risk groups, with a focus on morbidity, ovarian function, potential clinical applicability, and epidemiological considerations. Cancer 2017;123:1714-1720. © 2017 American Cancer Society.
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Affiliation(s)
- Kara C Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mlica Nourmoussavi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Irani M, Robles A, Gunnala V, Spandorfer SD. Unilateral Salpingectomy and Methotrexate Are Associated With a Similar Recurrence Rate of Ectopic Pregnancy in Patients Undergoing In Vitro Fertilization. J Minim Invasive Gynecol 2017; 24:777-782. [PMID: 28285056 DOI: 10.1016/j.jmig.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVE To determine whether different treatment approaches of ectopic pregnancy (EP), particularly unilateral salpingectomy and methotrexate, affect its recurrence rate in patients undergoing in vitro fertilization (IVF). DESIGN A retrospective cohort study (Canadian Task Force classification II-2). SETTING An academic medical center. PATIENTS Patients with a history of a previous EP who achieved pregnancy after IVF cycles between January 2004 and August 2015 were included. The recurrence rate of EP was compared between patients who underwent different treatment approaches for a previous EP. INTERVENTIONS IVF. MEASUREMENTS AND MAIN RESULTS A total of 594 patients were included. Seventeen patients had a recurrence of EP (2.9%). Patients with a history of ≥2 EPs were associated with a significantly higher recurrence rate of EP than those with 1 previous EP (8.5% vs. 1.8%; p = .01; odds ratio [OR] = 2.2; 95% confidence interval [CI], 1.2-4.4). Patients who underwent unilateral salpingectomy (n = 245) had a comparable recurrence rate of EP after IVF with those who received methotrexate (n = 283) (3.6% vs. 2.8%; p = .5; OR = 1.3; 95% CI, 0.4-3.4). This OR remained unchanged after adjusting for patient's age, number of previous EPs, number of transferred embryos, and peak estradiol level during stimulation (adjusted OR = 1.4; 95% CI, 0.5-3.8). None of the patients who underwent bilateral salpingectomy (n = 45) or salpingostomy (n = 21) had a recurrence of EP after IVF. CONCLUSION The recurrence rate of EP significantly correlates with the number of previous EPs. Treatment of EP with methotrexate has a comparable recurrence rate of EP after IVF with unilateral salpingectomy. Therefore, the risk of recurrence should not be a reason to favor salpingectomy over methotrexate in this population.
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Affiliation(s)
- Mohamad Irani
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Alex Robles
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
| | - Vinay Gunnala
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Steven D Spandorfer
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.
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The Role of Opportunistic Bilateral Salpingectomy vs Tubal Occlusion or Ligation for Ovarian Cancer Prophylaxis. J Minim Invasive Gynecol 2017; 24:371-378. [DOI: 10.1016/j.jmig.2017.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 12/31/2016] [Accepted: 01/04/2017] [Indexed: 01/11/2023]
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