Chirurgie annexielle prophylactique des femmes à risque héréditaire : vers de nouvelles pistes ?

Abstract

Hereditary ovarian carcinomas represent 10% of cases of the around 4,500 yearly ovarian cancers in France. They principally consist of high-grade serous carcinomas. They are especially observed in mutation carriers on genes BRCA1 or 2 and, at a lesser degree, on genes of the hereditary non-polyposis colorectal cancer (HNPCC) syndrome. Due to the absence of an effective screening method for this highly lethal disease, laparoscopic prophylactic adnexectomy is strongly recommended as soon as possible, after a genetic counselling session. However, not all women accept the outcomes of an early menopause, especially if a substitutive treatment is contra-indicated. Recent data obtained from the thorough examination of risk-reducing salpingo-oophorectomy (RRSO) specimens highlight the pivotal role of the Fallopian tube in the pathogenesis of most ovarian carcinomas, especially its fimbrial end for the high-grade serous subtype, so frequent with mutation carriers. Thus, for these at-risk women, reluctant to RRSO, the idea of a temporary prophylactic surgery, limited to a bilateral radical fimbriectomy until oophorectomy at menopause, is being assessed in a prospective study. Meanwhile, due to these informations, it is advocated as well to perform salpingectomies in non-at-risk patients, candidates for a conservative hysterectomy or a surgical tubal ligation, as a primary prophylaxis of this dreadful disease.