Introduction
Ovarian cancer is one the most lethal gynaecologic malignancies. The population risk of ovarian cancer is around 1%, with even higher risk, up to 40%, in cases of known family history, gene mutations or various hereditary syndromes.
There is currently no effective method of screening for ovarian cancer in high-risk women. The only effective intervention to reduce the risk of ovarian cancer is removal of both fallopian tubes and ovaries. This study aimed to investigate the surgical outcomes and occult cancer rates of risk-reducing salpingo-oophorectomy in high-risk women.
Methods
This is a retrospective analysis of all women identified as high-risk for ovarian cancer, who were referred to a high-volume tertiary center, and underwent risk reduction surgery. Included in the analysis were patients’ demographics, peri and post-operative details, and final histopathological details.
Results
Between 2009 and 2023 more than 1000 women were referred to our center for a risk reduction surgery. This is an interim analysis of 303 women from that cohort.
Of the 303 women who underwent risk-reducing surgery, 88 (29.1%) had a BRCA1 mutation (median age 44, range, 34-69 years), 107 (35.3%) BRCA2 mutation (median age 50 years, range 32-79 years), 30 (9.9%) with HNPCC associated gene mutations (median age 45 years, range 36-57 years), 59 (19.4%) with a family history (median age 52 years, range 33-68 years) and 19 (6.2%) with other rare gene mutations (median age 61, range 43-71 years).
The rate of intra and post operative complications was 7.2% of which 2.6% were major complications (Clavien-Dindo grade of 3 and higher). In nine patients (2.9%) surgeries converted to open.
The overall occult cancer rate was 3.9% (n=12): There were seven (58.3%) high grade serous of the ovary/fallopian tube (HGSOC) and five (41.7%) endometrial cancer found. Of the whole cohort, seven (2.3%) patients were found to have premalignant disease – four serous tubal intraepithelial carcinoma (STIC), two atypical endometrial hyperplasia (AEH) and one low grade dysplasia of the cervix.
11 out of 12 cancers were found in women with known mutations.
Discussion
In our study we found a lower rate of occult cancer when compared to the literature. This may be explained by inclusion women with a strong family history and not just a known mutation. A larger analysis of the whole cohort is to follow.