Prophylactic Radical Fimbriectomy with Delayed Oophorectomy in Women with a High Risk of Developing an Ovarian Carcinoma: Results of a Prospective National Pilot Study

Eric Leblanc, Fabrice Narducci, Gwenaël Ferron, Audrey Mailliez, Jean Yves Charvolin, El Hajj Houssein, Frédéric Guyon, Virginie Fourchotte, Eric Lambaudie, Agathe Crouzet, Yves Fouche, Sébastien Gouy, Pierre Collinet, Frédéric Caquant, Christophe Pomel, François Golfier, Véronique Vaini-Cowen, Isabelle Fournier, Michel Salzet, Emmanuelle TreschAlicia Probst, Anne Sophie Lemaire, Marie Cécile Le Deley, Delphine Hudry

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    Résumé

    Risk-reducing salpingo-oophorectomy is the gold standard for the prophylaxis of ovarian cancer in high-risk women. Due to significant adverse effects, 20–30% of women delay or refuse early oophorectomy. This prospective pilot study (NCT01608074) aimed to assess the efficacy of radical fimbriectomy followed by a delayed oophorectomy in preventing ovarian and pelvic invasive cancer (the primary endpoint) and to evaluate the safety of both procedures. The key eligibility criteria were pre-menopausal women ≥35 years with a high risk of ovarian cancer who refused a risk-reducing salpingo-oophorectomy. All the surgical specimens were subjected to the SEE-FIM protocol. From January 2012 to October 2014, 121 patients underwent RF, with 51 in an ambulatory setting. Occult neoplasia was found in two cases, with one tubal high-grade serous ovarian carcinoma. Two patients experienced grade 1 intraoperative complications. No early or delayed grade ≥3 post-operative complications occurred. After 7.3 years of median follow-up, no cases of pelvic invasive cancer have been noted. Three of the fifty-two patients developed de novo breast cancer. One BRCA1-mutated woman delivered twins safely. Twenty-five patients underwent menopause, including fifteen who had received chemotherapy for breast cancer, and twenty-three underwent menopause before the delayed oophorectomy, while two did not undergo a delayed oophorectomy at all. Overall, 46 women underwent a delayed oophorectomy. No abnormalities were found in any delayed oophorectomy specimens. Radical fimbriectomy followed by delayed oophorectomy appears to be a safe and well-tolerated risk-reducing approach, which avoids early menopause for patients with a high risk of breast and ovarian cancer.

    langue originaleAnglais
    Numéro d'article1141
    journalCancers
    Volume15
    Numéro de publication4
    Les DOIs
    étatPublié - 1 févr. 2023

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