Assessing the Risk of Occult Cancer and 30-day Morbidity in Women Undergoing Risk-reducing Surgery: A Prospective Experience

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Abstract

Study Objective To investigate the incidence and predictive factors of 30-day surgery-related morbidity and occult precancerous and cancerous conditions for women undergoing risk-reducing surgery. Design A prospective study (Canadian Task Force classification II-1). Setting A gynecologic oncology referral center. Patients Breast-related cancer antigen (BRCA) mutation carriers and BRCAX patients (those with a significant family history of breast and ovarian cancer). Interventions Minimally invasive risk-reduction surgery. Measurements and Main Results Overall, 85 women underwent risk-reducing surgery: 30 (35%) and 55 (65%) had hysterectomy plus bilateral salpingo-oophorectomy (BSO) and BSO alone, respectively. Overall, in 6 (7%) patients, the final pathology revealed unexpected cancer: 3 early-stage ovarian/fallopian tube cancers, 2 advanced-stage ovarian cancers (stage IIIA and IIIB), and 1 serous endometrial carcinoma. Additionally, 3 (3.6%) patients had incidental finding of serous tubal intraepithelial carcinoma. Four (4.7%) postoperative complications within 30 days from surgery were registered, including fever (n = 3) and postoperative ileus (n = 1); no severe (grade 3 or more) complications were observed. All complications were managed conservatively. The presence of occult cancer was the only factor predicting the development of postoperative complications (p =.02). Conclusion Minimally invasive risk-reducing surgery is a safe and effective strategy to manage BRCA mutation carriers. Patients should benefit from an appropriate counseling about the high prevalence of undiagnosed cancers observed at the time of surgery.

Original languageEnglish
Pages (from-to)837-842
Number of pages6
JournalJournal of Minimally Invasive Gynecology
Volume24
Issue number5
DOIs
Publication statusPublished - Jul 1 2017

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Morbidity
Ovariectomy
Neoplasms
Breast Neoplasms
Ambulatory Surgical Procedures
Ovarian Neoplasms
Fallopian Tube Neoplasms
Precancerous Conditions
Antigens
Mutation
Incidental Findings
Ileus
Carcinoma in Situ
Advisory Committees
Risk Reduction Behavior
Endometrial Neoplasms
Hysterectomy
Counseling
Fever
Referral and Consultation

Keywords

  • BRCA
  • Cancer
  • Laparoscopy
  • Morbidity

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

@article{90e22777960340f5a923222192e8e935,
title = "Assessing the Risk of Occult Cancer and 30-day Morbidity in Women Undergoing Risk-reducing Surgery: A Prospective Experience",
abstract = "Study Objective To investigate the incidence and predictive factors of 30-day surgery-related morbidity and occult precancerous and cancerous conditions for women undergoing risk-reducing surgery. Design A prospective study (Canadian Task Force classification II-1). Setting A gynecologic oncology referral center. Patients Breast-related cancer antigen (BRCA) mutation carriers and BRCAX patients (those with a significant family history of breast and ovarian cancer). Interventions Minimally invasive risk-reduction surgery. Measurements and Main Results Overall, 85 women underwent risk-reducing surgery: 30 (35{\%}) and 55 (65{\%}) had hysterectomy plus bilateral salpingo-oophorectomy (BSO) and BSO alone, respectively. Overall, in 6 (7{\%}) patients, the final pathology revealed unexpected cancer: 3 early-stage ovarian/fallopian tube cancers, 2 advanced-stage ovarian cancers (stage IIIA and IIIB), and 1 serous endometrial carcinoma. Additionally, 3 (3.6{\%}) patients had incidental finding of serous tubal intraepithelial carcinoma. Four (4.7{\%}) postoperative complications within 30 days from surgery were registered, including fever (n = 3) and postoperative ileus (n = 1); no severe (grade 3 or more) complications were observed. All complications were managed conservatively. The presence of occult cancer was the only factor predicting the development of postoperative complications (p =.02). Conclusion Minimally invasive risk-reducing surgery is a safe and effective strategy to manage BRCA mutation carriers. Patients should benefit from an appropriate counseling about the high prevalence of undiagnosed cancers observed at the time of surgery.",
keywords = "BRCA, Cancer, Laparoscopy, Morbidity",
author = "Giorgio Bogani and Elena Tagliabue and Mauro Signorelli and Valentina Chiappa and Carcangiu, {Maria Luisa} and Biagio Paolini and Jvan Casarin and Cono Scaffa and Massimiliano Gennaro and Fabio Martinelli and Chiara Borghi and Antonino Ditto and Domenica Lorusso and Francesco Raspagliesi",
year = "2017",
month = "7",
day = "1",
doi = "10.1016/j.jmig.2017.04.017",
language = "English",
volume = "24",
pages = "837--842",
journal = "Journal of Minimally Invasive Gynecology",
issn = "1553-4650",
publisher = "Elsevier",
number = "5",

}

TY - JOUR

T1 - Assessing the Risk of Occult Cancer and 30-day Morbidity in Women Undergoing Risk-reducing Surgery

T2 - A Prospective Experience

AU - Bogani, Giorgio

AU - Tagliabue, Elena

AU - Signorelli, Mauro

AU - Chiappa, Valentina

AU - Carcangiu, Maria Luisa

AU - Paolini, Biagio

AU - Casarin, Jvan

AU - Scaffa, Cono

AU - Gennaro, Massimiliano

AU - Martinelli, Fabio

AU - Borghi, Chiara

AU - Ditto, Antonino

AU - Lorusso, Domenica

AU - Raspagliesi, Francesco

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Study Objective To investigate the incidence and predictive factors of 30-day surgery-related morbidity and occult precancerous and cancerous conditions for women undergoing risk-reducing surgery. Design A prospective study (Canadian Task Force classification II-1). Setting A gynecologic oncology referral center. Patients Breast-related cancer antigen (BRCA) mutation carriers and BRCAX patients (those with a significant family history of breast and ovarian cancer). Interventions Minimally invasive risk-reduction surgery. Measurements and Main Results Overall, 85 women underwent risk-reducing surgery: 30 (35%) and 55 (65%) had hysterectomy plus bilateral salpingo-oophorectomy (BSO) and BSO alone, respectively. Overall, in 6 (7%) patients, the final pathology revealed unexpected cancer: 3 early-stage ovarian/fallopian tube cancers, 2 advanced-stage ovarian cancers (stage IIIA and IIIB), and 1 serous endometrial carcinoma. Additionally, 3 (3.6%) patients had incidental finding of serous tubal intraepithelial carcinoma. Four (4.7%) postoperative complications within 30 days from surgery were registered, including fever (n = 3) and postoperative ileus (n = 1); no severe (grade 3 or more) complications were observed. All complications were managed conservatively. The presence of occult cancer was the only factor predicting the development of postoperative complications (p =.02). Conclusion Minimally invasive risk-reducing surgery is a safe and effective strategy to manage BRCA mutation carriers. Patients should benefit from an appropriate counseling about the high prevalence of undiagnosed cancers observed at the time of surgery.

AB - Study Objective To investigate the incidence and predictive factors of 30-day surgery-related morbidity and occult precancerous and cancerous conditions for women undergoing risk-reducing surgery. Design A prospective study (Canadian Task Force classification II-1). Setting A gynecologic oncology referral center. Patients Breast-related cancer antigen (BRCA) mutation carriers and BRCAX patients (those with a significant family history of breast and ovarian cancer). Interventions Minimally invasive risk-reduction surgery. Measurements and Main Results Overall, 85 women underwent risk-reducing surgery: 30 (35%) and 55 (65%) had hysterectomy plus bilateral salpingo-oophorectomy (BSO) and BSO alone, respectively. Overall, in 6 (7%) patients, the final pathology revealed unexpected cancer: 3 early-stage ovarian/fallopian tube cancers, 2 advanced-stage ovarian cancers (stage IIIA and IIIB), and 1 serous endometrial carcinoma. Additionally, 3 (3.6%) patients had incidental finding of serous tubal intraepithelial carcinoma. Four (4.7%) postoperative complications within 30 days from surgery were registered, including fever (n = 3) and postoperative ileus (n = 1); no severe (grade 3 or more) complications were observed. All complications were managed conservatively. The presence of occult cancer was the only factor predicting the development of postoperative complications (p =.02). Conclusion Minimally invasive risk-reducing surgery is a safe and effective strategy to manage BRCA mutation carriers. Patients should benefit from an appropriate counseling about the high prevalence of undiagnosed cancers observed at the time of surgery.

KW - BRCA

KW - Cancer

KW - Laparoscopy

KW - Morbidity

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U2 - 10.1016/j.jmig.2017.04.017

DO - 10.1016/j.jmig.2017.04.017

M3 - Article

AN - SCOPUS:85019993024

VL - 24

SP - 837

EP - 842

JO - Journal of Minimally Invasive Gynecology

JF - Journal of Minimally Invasive Gynecology

SN - 1553-4650

IS - 5

ER -