Abstract
Objective. To establish short-term surgical outcomes of three-port laparoscopic risk-reducing salpingo-oophorectomy (RRSO) in women with hereditary breast-ovarian cancer syndrome (HBOC). Methods. The medical records of all HBOC women that underwent laparoscopic RRSO between January 2001 and December 2010 were retrospectively reviewed. Demographic data, operative details, and short-term surgical outcomes were obtained and subjected to SAS. Statistical univariate and multivariate analyses were performed. Results. 358 patients met study criteria with 277 (77.4%) carrying a documented BRCA mutation. The predominant technique utilized three ports (two 5 mm and one 10/12 mm), a 5 mm laparoscope and a 5 mm Ligasure pulsatile bipolar device. Mean operative time was 58.3 minutes (SD 22.6, 26.0–197.0), significantly affected by BMI greater than 30 (P<0.0001) and status of adhesions (P=0.001). Estimated blood loss (EBL) was negligible in 96.9% of cases. Seven patients required conversion to laparotomy. No major intraoperative complications were recorded. One-night hospital admission rate was less than 2.0% while postoperative complication rate was 3.1%. Malignancy was revealed in 14 patients (3.9%). Conclusion. In HBOC population, three-port laparoscopic RRSO is a simple, reproducible, and safe procedure with low conversion rate, short operative time, minimal EBL, low surgical morbidity, and rapid postoperative recovery.
Highlights
Risk-reducing salpingo-oophorectomy (RRSO) is considered the gold standard for ovarian, fallopian, and primary peritoneal cancer prevention in women with documented BRCA-1 and -2 mutations or family history consistent with hereditary breast-ovarian cancer syndrome (HBOC) [1, 2]
BRCA-1 carriers were more likely to be premenopausal when compared to other subgroups (P = 0.02). 173 of 357 patients (48.5%) had prior history of abdominal surgery with 126 of them having at least one prior laparotomy. 52.9% of women were treated for previously diagnosed breast cancer
The outlined surgical steps constitute a feasible and reproducible technique, as evidenced by the median operative time of 55 minutes which is considerably shorter than the 105 minutes reported by Kenkhuis et al [12]
Summary
Risk-reducing salpingo-oophorectomy (RRSO) is considered the gold standard for ovarian, fallopian, and primary peritoneal cancer prevention in women with documented BRCA-1 and -2 mutations or family history consistent with hereditary breast-ovarian cancer syndrome (HBOC) [1, 2]. Despite its common utilization in the general population, short-term surgical outcomes, morbidity, and overall safety of standardized laparoscopic salpingo-oophorectomy (LSO) in the particular cohort of HBOC women have not been established far. The application of LSO for riskreducing purposes is often accompanied by considerable differences compared to reports derived from the general population. This is mostly attributed to the higher rate of previous abdominal surgeries performed in HBOC women, including transverse rectus abdominis myocutaneous (TRAM) flaps for breast reconstruction.
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