Our Summary

This study compared the outcomes and costs of two different surgical approaches for patients with invasive breast cancer or BRCA1/BRCA2 mutations. These patients underwent both breast surgery (either removal of the entire breast aka mastectomy, or removal of just the lump in the breast aka lumpectomy) and removal of both ovaries and fallopian tubes (bilateral salpingo-oophorectomy or BSO). The two approaches were either doing both surgeries at the same time (coordinated) or doing them separately (staged).

The researchers studied the medical records of 4228 patients who had these surgeries between 2010 and 2015. They found that 9.7% of the patients had the surgeries at the same time (coordinated) while 90.3% had them separately (staged). They found that patients who had the surgeries at the same time had more complications after surgery (24.0% vs. 17.7%) and also had a higher risk of complications even after adjusting for other factors (odds ratio 1.37). The cost of healthcare was similar for both groups.

Interestingly, when they looked specifically at patients who only had a lumpectomy (removal of the lump, not the whole breast), they found that the rate of complications was similar whether the surgeries were done together or separately.

In conclusion, while the costs were similar, doing the breast surgery and BSO at the same time was associated with more complications for patients who had their whole breast removed, but not for those who just had the lump removed. This information could be useful when doctors and patients are deciding on the best surgical approach.

FAQs

  1. What were the two surgical approaches studied for patients with invasive breast cancer or BRCA1/BRCA2 mutations?
  2. Did the study find higher complication rates for patients who had both breast surgery and BSO at the same time or separately?
  3. Did the cost of healthcare differ between the two surgical approaches?

Doctor’s Tip

A doctor might tell a patient considering salpingo-oophorectomy that while the surgery can be done at the same time as other procedures, such as mastectomy for breast cancer, there may be a higher risk of complications compared to having the surgeries done separately. It’s important to weigh the potential risks and benefits with your healthcare team when deciding on the best treatment plan.

Suitable For

Patients who are typically recommended salpingo-oophorectomy include those with invasive breast cancer or BRCA1/BRCA2 mutations. These patients may undergo this surgery as a preventive measure to reduce their risk of developing ovarian and fallopian tube cancers, which are more common in individuals with these genetic mutations. Additionally, patients with certain gynecological conditions such as ovarian cysts or tumors may also be recommended for salpingo-oophorectomy.

Timeline

Before the salpingo-oophorectomy:

  • Patient is diagnosed with invasive breast cancer or BRCA1/BRCA2 mutations
  • Patient and doctor discuss treatment options, including surgical removal of both ovaries and fallopian tubes
  • Decision is made to proceed with bilateral salpingo-oophorectomy
  • Pre-surgical consultations and tests are conducted to prepare for the surgery

After the salpingo-oophorectomy:

  • Surgery is performed to remove both ovaries and fallopian tubes
  • Patient may experience post-operative pain, discomfort, and recovery time
  • Follow-up appointments are scheduled to monitor healing and recovery
  • Patient may experience menopausal symptoms if ovaries are removed
  • Long-term monitoring and hormone replacement therapy may be necessary for some patients, depending on individual health factors and risks.

What to Ask Your Doctor

  1. What is the purpose of a salpingo-oophorectomy in my case?
  2. What are the potential risks and complications associated with a salpingo-oophorectomy?
  3. What are the benefits of having a coordinated approach (both breast surgery and BSO done at the same time) versus a staged approach (done separately)?
  4. How will having a salpingo-oophorectomy impact my overall treatment plan and prognosis?
  5. Are there any alternative treatment options to consider instead of a salpingo-oophorectomy?
  6. How will having a salpingo-oophorectomy affect my hormone levels and menopausal symptoms?
  7. What is the recovery process like after a salpingo-oophorectomy?
  8. How often will I need follow-up appointments or monitoring after the surgery?
  9. Are there any lifestyle changes or precautions I should take after having a salpingo-oophorectomy?
  10. Are there any long-term implications or considerations to keep in mind after having a salpingo-oophorectomy?

Reference

Authors: Vemuru SR, Bronsert M, Vossler K, Huynh VD, Beaty L, Ahrendt G, Arruda J, Kaoutzanis C, Rojas KE, Bozzuto L, Kim S, Tevis SE. Journal: Ann Surg Oncol. 2023 Sep;30(9):5667-5680. doi: 10.1245/s10434-023-13630-0. Epub 2023 Jun 19. PMID: 37336806