Our Summary

This study looked at the number of women who had their ovaries and fallopian tubes removed (bilateral salpingo-oophorectomy or BSO) at the same time as having their uterus removed (hysterectomy) in seven hospitals in Ontario, Canada, from 2016 to 2019. They wanted to see how often this extra surgery was really necessary, based on what the removed organs looked like under a microscope (pathologic diagnosis). They excluded surgeries done by cancer doctors or for a condition where the placenta invades too deeply into the uterus.

They found that out of 4,191 hysterectomies, 1,422 also included BSO. In most cases (72.8%), the extra surgery was justified based on the pathologic diagnosis, with endometrial (uterine) cancer being the most common reason. However, in 5.6% of cases (79 out of 1,422), they determined that the BSO could have been avoided.

These avoidable BSOs were more often done by general surgeons rather than specialists, and for conditions like abnormal uterine bleeding, heavy periods, and fibroids. The researchers conclude that most of the time, BSO at the time of hysterectomy is justified, but in about 5.6% of cases it may not be necessary, suggesting that doctors should be more careful about deciding when to perform this additional procedure.

FAQs

  1. What is a bilateral salpingo-oophorectomy (BSO) and when is it typically performed?
  2. What were the findings of the study on BSOs performed during hysterectomies in Ontario hospitals from 2016 to 2019?
  3. What are some of the conditions that may lead to avoidable BSOs, according to the study?

Doctor’s Tip

A doctor might tell a patient considering salpingo-oophorectomy that while it is often necessary, it is important to carefully consider whether it is truly needed in their specific case. It is important to discuss the potential risks and benefits of the procedure, as well as alternative options, before making a decision. Additionally, it is important to ensure that the surgeon performing the procedure is a specialist in gynecologic surgery to minimize the risk of unnecessary surgeries.

Suitable For

Patients who are typically recommended salpingo-oophorectomy include those with a high risk of ovarian or fallopian tube cancer, such as those with a family history of these cancers or a personal history of breast cancer. Additionally, patients with pre-cancerous or cancerous conditions of the ovaries, fallopian tubes, or uterus may also be recommended this surgery. Other reasons for recommending salpingo-oophorectomy may include the presence of certain genetic mutations (such as BRCA1 or BRCA2) that increase the risk of ovarian or breast cancer, or the presence of certain benign conditions that may warrant removal of the ovaries and fallopian tubes.

Timeline

Before the salpingo-oophorectomy:

  • Patient undergoes a consultation with their doctor to discuss the need for a hysterectomy
  • Patient may undergo pre-operative testing and evaluation to determine if they are a suitable candidate for surgery
  • Patient receives information about the risks and benefits of the surgery, including the option to also have their ovaries and fallopian tubes removed
  • Decision is made to proceed with a hysterectomy and potentially include a salpingo-oophorectomy

After the salpingo-oophorectomy:

  • Patient undergoes the surgery, which involves the removal of the uterus, ovaries, and fallopian tubes
  • Patient may experience pain and discomfort in the days following the surgery
  • Patient may have a longer recovery time compared to a hysterectomy alone
  • Patient may experience menopausal symptoms such as hot flashes, night sweats, and mood changes due to the removal of the ovaries
  • Patient may require hormone replacement therapy to manage menopausal symptoms
  • Patient may have follow-up appointments with their doctor to monitor their recovery and overall health post-surgery

What to Ask Your Doctor

  1. Why do I need a salpingo-oophorectomy in addition to a hysterectomy?
  2. What are the potential risks and complications of having both procedures done at the same time?
  3. Are there alternative treatment options that do not involve removing my ovaries and fallopian tubes?
  4. How will removing my ovaries and fallopian tubes affect my hormone levels and overall health?
  5. What is the likelihood that the pathology report will show that the extra surgery was not necessary?
  6. Are there any specific factors about my health or medical history that make me a candidate for or against having a salpingo-oophorectomy?
  7. How will removing my ovaries and fallopian tubes impact my fertility and menopausal symptoms?
  8. Will I need to take hormone replacement therapy after the surgery?
  9. What is the recovery process like for having a salpingo-oophorectomy in addition to a hysterectomy?
  10. Can you explain the difference between a necessary and avoidable salpingo-oophorectomy in my case?

Reference

Authors: Iancu AM, Murji A, Chow O, Shapiro J, Cipolla A, Shirreff L. Journal: Menopause. 2022 May 1;29(5):523-530. doi: 10.1097/GME.0000000000001951. PMID: 35324543