Surgical Findings and Outcomes in Premenopausal Breast Cancer Patients Undergoing Oophorectomy: A Multicenter Review From the Society of Gynecologic Surgeons Fellows Pelvic Research Network

Authors

Lara F. Harvey, Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: Lara.harvey@vanderbilt.edu.
Vandana G. Abramson, Division of Hematology/Oncology, Vanderbilt Ingram Cancer Center, Nashville, Tennessee.
Jimena Alvarez, Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, Illinois.
Christopher DeStephano, Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida.
Hye-Chun Hur, Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Katherine Lee, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana.
Patricia Mattingly, Division of Gynecologic Specialty Surgery, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York.
Beau Park, Department of Obstetrics and Gynecology, Mayo Clinic Arizona, Phoenix, Arizona.
Carolyn Piszczek, Division of Gynecologic Oncology, Legacy Cancer Institute, Legacy Health, Portland, Oregon.
Farinaz Seifi, Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Yale New Haven Health/Bridgeport Hospital, Bridgeport, Connecticut.
Mallory Stuparich, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Amanda Yunker, Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee.

Document Type

Article

Publication Title

Journal of minimally invasive gynecology

Abstract

STUDY OBJECTIVE: To describe the procedures performed, intra-abdominal findings, and surgical pathology in a cohort of women with premenopausal breast cancer who underwent oopherectomy. DESIGN: Multicenter retrospective chart review (Canadian Task Force classification II-3). SETTING: Nine US academic medical centers participating in the Fellows' Pelvic Research Network (FPRN). PATIENTS: One hundred twenty-seven women with premenopausal breast cancer undergoing oophorectomy between January 2013 and March 2016. INTERVENTION: Surgical castration. MEASUREMENTS AND MAIN RESULTS: The mean patient age was 45.8 years. Fourteen patients (11%) carried a BRCA mutations, and 22 (17%) carried another germline or acquired mutation, including multiple variants of uncertain significance. There was wide variation in surgical approach. Sixty-five patients (51%) underwent pelvic washings, and 43 (35%) underwent concurrent hysterectomy. Other concomitant procedures included midurethral sling placement, appendectomy, and hysteroscopy. Three patients experienced complications (transfusion, wound cellulitis, and vaginal cuff dehiscence). Thirteen patients (10%) had ovarian pathology detected on analysis of the surgical specimen, including metastatic tumor, serous cystadenomas, endometriomas, and Brenner tumor. Eight patients (6%) had Fallopian tube pathology, including 3 serous tubal intraepithelial cancers. Among the 44 uterine specimens, 1 endometrial adenocarcinoma and 1 multifocal endometrial intraepithelial neoplasia were noted. Regarding the entire study population, the number of patients meeting our study criteria and seen by gynecologic surgeons in the FPRN for oophorectomy increased by nearly 400% from 2013 to 2015. CONCLUSION: Since publication of the Suppression of Ovarian Function Trial data, bilateral oophorectomy has been recommended for some women with premenopausal breast cancer to facilitate breast cancer treatment with aromatase inhibitors. These women may be at elevated risk for occult abdominal pathology compared with the general population. Gynecologic surgeons often perform castration oophorectomy in patients with breast cancer as an increasing number of oncologists are using aromatase inhibitors to treat premenopausal breast cancer. Our data suggest that other abdominal/pelvic cancers, precancerous conditions, and previously unrecognized metastatic disease are not uncommon findings in this patient population. Gynecologists serving this patient population may consider a careful abdominal survey, pelvic washings, endometrial sampling, and serial sectioning of fallopian tube specimens for a thorough evaluation.

First Page

111

Last Page

115

DOI

10.1016/j.jmig.2017.08.643

Publication Date

1-1-2018

Recommended Citation

Harvey, Lara F.; Abramson, Vandana G.; Alvarez, Jimena; DeStephano, Christopher; Hur, Hye-Chun; Lee, Katherine; Mattingly, Patricia; Park, Beau; Piszczek, Carolyn; Seifi, Farinaz; Stuparich, Mallory; and Yunker, Amanda, "Surgical Findings and Outcomes in Premenopausal Breast Cancer Patients Undergoing Oophorectomy: A Multicenter Review From the Society of Gynecologic Surgeons Fellows Pelvic Research Network" (2018). MIGs. 2.
https://scholar.bridgeporthospital.org/migs/2

Identifier

28821472 (pubmed); 10.1016/j.jmig.2017.08.643 (doi); S1553-4650(17)31085-3 (pii)