Risk-Reducing Salpingo-Oophorectomy for BRCA Carriers: Is There a Benefit to Combination With Breast Surgery? [17J

Abstract

INTRODUCTION: Patients with BRCA mutations must decide whether and when to perform risk-reducing salpingo-oophorectomy (RRSO). The combination of RRSO with mastectomy and/or breast reconstructive surgery is an attractive option. We evaluate the postoperative complication rates of RRSO in combination with breast surgery compared to RRSO alone. METHODS: A retrospective chart review was performed to identify patients treated with RRSO for a BRCA mutation at our institutions from 2002 through August 2016. Statistical analysis was performed using unpaired student's t, Fisher’s exact and chi-square tests. RESULTS: Out of 127 patients, 44 had combined breast and RRSO surgery while 83 had RRSO alone. Median age, BMI, and comorbidities were similar for both groups. The frequency of hysterectomy was also comparable: 41% in the combined vs. 46% in the RRSO group. Patients undergoing combined surgery had significantly longer mean operative times (412 vs. 164 min), more blood loss (218 vs. 96 mL), and longer hospital stay (3 vs. 1.4 days). However, the overall postoperative complication rates were similar between the two groups. Although most gynecologic procedures were performed laparoscopically, the RRSO group had more robotic surgeries and the combined surgery group had more laparotomies. CONCLUSION: For women with a BRCA mutation, it is a feasible and reasonable option to undergo risk-reducing salpingo-oophorectomy at the time of breast surgery. Combined surgery is associated with longer operative time, more blood loss, and longer hospital stay, but this was not associated with worsened postoperative outcomes. Further research is warranted to evaluate patient satisfaction and the cost-effectiveness of combined surgeries.