Page 9 - WALS Journal

WJOLS

Laparoendoscopic Single-Site Surgery in Gynecologic Oncology
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essential role in the treatment of this disease. Minimally oophorectomies of 99.75% women undergoing
invasive surgical techniques have been utilized with hysterectomies in order to avoid ovarian cancer in 0.25%
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increasing frequency in the management of endometrial need more further assessment. However, there is a recent
cancer, minimally invasive surgery have demonstrated the study in Japan, where the incidence of ovarian cancer is
safety and feasibility of laparoscopy in performing very low and failed to prove the significance of prophylactic
hysterectomy, bilateral salpingo-oophorectomy, and pelvic oophorectomies to spare cancer ovary in all women over
and periaortic lymphadenectomy for surgical staging in age 45 undergoing hysterectomy. 25
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endometrial cancer. The use of minimally invasive There is another study which suggests that women who
techniques does not appear to have an adverse impact on undergo a hysterectomy are actually at low risk for
survival, and it improves quality of life in the postoperative development of ovarian cancer. So the indications of
period. prophylactic oophorectomy may include postmenopausal
Some gynecologist find high incidence of positive women, nulliparous women, women with long history of
peritoneal cytology for the endometrial cancer in patients infertility, women with past history of breast, colon and
after laparoscopy, this may be due to the retrograde uterine cancer and women with a genetic predisposition to
dissemination of cancer cells into the peritoneal cavity developing ovarian cancer. However, we must remove the
during uterine manipulation, but the clinical significance ovaries of the patients with a past history of breast, colon
of these findings is not clear yet. Many studies proved that or uterine cancer if abdominal surgery will be performed
obesity is not a contraindication to laparoscopic staging in because the ovaries are common sites for metastasis.
endometrial cancer. This is an important consideration, as
many patients with endometrial cancer are obese. 22 LESS RISK-REDUCING OOPHORECTOMY
However, minimally invasive surgical techniques which Definition of the Concept
are used in management of endometrial cancer include Risk reducing bilateral salpingo-oophorectomy (rrBSO) is
instrumentation, and technology have improved a method for decreasing the risk of ovarian cancer in women
significantly. The application of these techniques in with a genetic disposition for this malignancy. This
treatment of endometrial cancer is safe and effective procedure is done because of the efficacy of current
alternative to laparotomy and appears to provide similar modalities is limited for early detection and there is high
result and survival rates. Patient benefit is demonstrated mortality rate associated with ovarian cancer.
by faster recovery, decreased pain and improved quality
of life. Indications of Risk-reducing Oophorectomy
Before performing rrBSO, it is important to differentiate
LESS ELECTIVE OOPHORECTOMY between women with possible familial ovarian cancer
Definition of the Concept syndromes, which is rare syndrome, and other women who
have no familial ovarian cancer syndromes and no one in
This is the mean removal of the ovaries with another there family having it. The familial ovarian cancer
indicated surgical operation, it is always removed to prevent syndromes account for approximately 10% of cases of
morbidity or mortality, which can occur later on if the epithelial ovarian cancer. The key for diagnosis of these
ovaries are left. hereditary syndromes is the presence of ovarian cancer in a
Elective oophorectomy has a great benefit because we family member at any age, or appearance of breast cancer
presently lack the ability to routinely recognize ovarian in premenopausal women and the occurrence of cancers in
cancer in a premalignant form or even when it is confined multiple members of two to four generations. 26
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as early invasive cancer to the ovary itself, as a result The familial cancer syndromes include:
most ovarian cancers are present as advanced stage of the • Site-specific ovarian cancer syndrome.
disease and the cure rates are low. • Breast-ovarian cancer syndrome.
• Hereditary nonpolyposis colorectal cancer syndrome
Indications of Elective Oophorectomy
(HNPCC).
A number of surgeons have suggested that elective bilateral The first two groups are associated with gene mutations
salpingo-oophorectomies in women over age 40 should in the BRCA1 and BRCA2 genes but hereditary colon
routinely undergo at the time of hysterectomy. If a cancer syndrome (HNPCC) is associated with gene mutation
prophylactic oophorectomy was performed in all women in DNA mismatch repair (MMR) genes.
over age 40 years, 2,200 women may subsequently avoid Most ovarian cancers associated with the BRCA
ovarian cancer per year. This concept of bilateral salpingo- mutations are diagnosed at a younger age and mostly are
World Journal of Laparoscopic Surgery, September-December 2012;5(3):121-127 123