Laparoscopic Oophorectomy in the Management of Breast Disease

Abstract

Background: Oophorectomy is being increasingly carried out in the management of breast disease, as either adjuvant treatment for breast cancer or for prevention of ovarian and fallopian tube cancer in BRCA gene mutation carriers. The aims of this study were to determine the surgical outcome of laparoscopic oophorectomy when carried out by breast surgeons and whether laparoscopic oophorectomy can be safely carried out during the same anaesthesia as breast surgery. Methods: Patients who had laparoscopic oophorectomy carried out by two breast surgeons were reviewed with regard to the indication, surgical outcome and concurrent procedures. Salpingectomy was also carried out when the indication was prevention. Results: Seventy patients with breast disease had laparoscopic oophorectomy between January 2000 and June 2007. Forty-three patients had laparoscopic oophorectomy for adjuvant endocrine treatment of early breast cancer, 13 for prophylaxis, 7 for endocrine and prophylactic reasons and 7 for treatment of metastatic breast cancer. Sixteen patients had laparoscopic oophorectomy and breast surgery at the same time, without complication. Of note, four BRCA mutation carriers had prophylactic mastectomies, bilateral breast reconstruction and bilateral laparoscopic salpingo-oophorectomy. No patient required conversion to an open procedure, including 29 patients with previous abdominal surgery. There were no significant complications. Three patients had ovarian cancer or breast cancer detected in an ovary. Conclusion: Laparoscopic oophorectomy can be safely and efficiently carried out by breast surgeons with expertise in laparoscopic surgery. Previous abdominal surgery did not prevent a successful laparoscopic approach. Breast oncological and/or reconstructive surgery and laparoscopic oophorectomy can be reliably carried out as a combined procedure.

Decision making for breast cancer prevention among women at elevated risk

“…There is, however, a sparse evidence base for these comparisons and combinations [69, 70]. It is known that BRCA mutation carriers can achieve greater risk reduction by undergoing both BPM and BPSO than either alone [27, 71], and that prophylactic surgeries generally reduce both cancer risk and anxiety about cancer [28]. BPSO is likely the single intervention with the best risk-benefit ratio for BRCA mutation carriers [72, 73].…”

Potential adverse impact of ovariectomy on physical and psychological function of younger women with breast cancer

“…10 Ovariectomy has been increasingly used as adjuvant treatment of BC with improvement in the prognosis of estrogen receptorYpositive early BC in premenopausal women. 12,13 However, ovariectomy in premenopausal younger women precipitates the onset of premature/early menopause. More than 90% of women will develop menopausal symptoms after bilateral ovariectomy.…”

“…1-6) and depression (question nos. 7-11).Somatic symptoms (question nos [12][13][14][15][16][17][18][19][20]…”

Risk-reducing strategies for women carrying brca1/2 mutations with a focus on prophylactic surgery

“…Such data demonstrate the utility of BSO in this population of patients given the fact that the procedure can be performed laparoscopically with minimal invasiveness, high efficacy, and low morbidity[96]. Chemoprevention with anti-oestrogens--especially in BRCA2 carriers--and breast surveillance can be added to PBSO in order to enhance its effective prophylactic role with a limited impact on quality of life.…”