[en] [en] BACKGROUND: Ovarian carcinoma is a leading cause of cancer-related mortality in women. Approximately 20 % of cases are hereditary, mainly BRCA mutations. Current clinical guidelines recommend bilateral salpingo-oophorectomy between ages 35-45 for high-risk individuals, leading to premature menopause. Given evidence supporting the tubal origin of most ovarian cancers, radical fimbriectomy followed by delayed oophorectomy may offer a menopause-sparing alternative for women refusing early ovariectomy.
OBJECTIVE: To evaluate the oncologic safety and clinical outcomes of this two-step risk-reducing strategy.
METHODS: This retrospective single-center study included all high-risk premenopausal women who had completed childbearing, declined BSO and underwent radical fimbriectomy between 2014 and 2022. The primary outcome was the incidence of ovarian or pelvic cancer following radical fimbriectomy, estimated using the Kalbfleisch-Prentice method. Secondary outcomes included surgical complications, tubal lesions, menopause onset, breast cancer incidence and delayed oophorectomy rate.
RESULTS: A total of 132 women were included; 62.9 % had BRCA1, 25.8 % BRCA2, and 11.3 % other high-risk mutations (RAD51C, PALB2). No tubal lesions were found in 121 cases (91.7 %), while 11 (8.3 %) had abnormalities: one high-grade serous carcinoma, six serous tubal intraepithelial carcinoma, and four minor lesions. After a median 30.4-month follow-up, no high-grade serous carcinoma was reported. Delayed bilateral oophorectomy was performed in 24 women (18.5 %), and menopause occurred in 27 at a median age of 45. One pregnancy occurred post-fimbriectomy via assisted reproductive technology.
CONCLUSION: Radical fimbriectomy with delayed oophorectomy may be a safe and feasible option for high-risk women seeking to avoid early menopause. Longer-term prospective studies are needed.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Schoenen, Sophie ; Université de Liège - ULiège > Département des sciences cliniques ; Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France. Electronic address: s-schoenen@o-lambret.fr
Martinez Gomez, Carlos; Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France
Pasquesoone, Camille; Department of Pathology, Centre Oscar Lambret, Lille, France
Alline, Julie; Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France
Duchatelet, Mathilde; Department of Gynecology and Obstetrics, Victor Provo Hospital, Roubaix, France
Risbourg, Séverine; Biostatistics Unit, DRCI, Centre Oscar Lambret, Lille, France
Mailliez, Audrey; Department of Medical Oncology, Centre Oscar Lambret, Lille, France
Ben Miled, Aïcha; Department of Radiology, Centre Oscar Lambret, Lille, France
Saint-Ghislain, Mathilde; Department of Medical Oncology, Centre Oscar Lambret, Lille, France
Serouart, Benjamin; Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France
Fidlers, Tom ; Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France
Bresson, Lucie; Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France
Navarro, Anne-Sophie; Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France
Le Deley, Marie-Cécile; Biostatistics Unit, DRCI, Centre Oscar Lambret, Lille, France
Narducci, Fabrice; Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France
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