Perioperative Outcomes Following Opportunistic Bilateral Salpingo-Oophorectomy at the Time of Sacrocolpopexy

Abstract

<h3>Study Objective</h3> Surgeons commonly opt to perform an opportunistic bilateral salpingo-oophorectomy (BSO) for peri- and postmenopausal women who undergo pelvic reconstructive surgery (PRS) in order to prevent future development of malignancy. The prevalence of underlying gynecologic malignancy amongst this population is not well defined in medical literature. There is also limited information on the impact of an opportunistic BSO on perioperative outcomes. This study aims to investigate the oncologic incidence and perioperative outcomes for those undergoing robotic-assisted laparoscopic sacrocolpopexy (RA-SCP) for pelvic organ prolapse (POP) with and without a concomitant BSO. <h3>Design</h3> Retrospective descriptive analysis. <h3>Setting</h3> University-affiliated community hospital. <h3>Patients or Participants</h3> Cases of patients who underwent a RA-SCP without hysterectomy (n=283) by one surgeon between March 2017 and March 2020. <h3>Interventions</h3> RA-SCP with concomitant BSO (n=150) versus without BSO (n=133). <h3>Measurements and Main Results</h3> A total of 2 patients (0.7%) were found to have malignant adnexal pathology: 2 high grade serous cancers of the fallopian tube with no ovarian cancers detected. Cases with concomitant BSO required statistically significant longer operative times (215 vs 197 mins, p<0.05). Morphine milligram equivalents (MME) used in the post-anesthesia care unit (PACU) and the recovery floor were comparable between with and without BSO groups (2.95 and 20.09 MME, vs 3.14 and 22.55 MME, p=0.59, p=0.49), respectively. Quantitative blood loss was similar amongst both groups (-2.12 and -2.31 g/dL, p=0.08). Demographics were without statistical differences between groups. <h3>Conclusion</h3> Performing opportunistic BSOs at the time of PRS with a RA-SCP is a well-tolerated procedure. A small subset of patients were found to have gynecologic cancer. Surgeons should counsel patients regarding the safety profile of opportunistic BSO and the potential to detect cancer in patients with POP who otherwise have no suspicion for adnexal malignancy.