外科ジャーナル

Adnexectomy Versus Ovarian Conservation During Total Hysterectomy for Benign Conditions. A Difficult Dilemma

Abstract

Ion Păun, Dan Mogoş, Mariana Păun, Costin-Daniel Vidrighin, Mihai Florescu, Mădălin Teodorescu, Andrei Costin, Ecaterina Neamţu and Ana-Maria Predoi

Introduction: Bilateral adnexectomy is a surgical procedure that is frequently associated with total hysterectomy performed for benign uterine conditions. Given the relatively wide range of indications for the aforementioned type of salpingo-ooforectomy which in it self is not devoid of potential risks the patients' and physicians' decision-making should take into account several parameters (most helpful to individualize treatment) such as published ratio of removal versus conservation of uterine adnexae, patients' age, pre/postmenopausal status at the time of surgery, relevant family and personal history including current use of hormonal replacement therapy.

Materials and Methods: This retrospective cohort study was conducted among 457 women aged 18 years or older who underwent abdominal total hysterectomies for benign uterine conditions between 2000 and 2011. The study patients were stratified by age for better characterization and according to recent publications.

Results: Uni- or bilateral oophorectomy was performed in 50% of the subgroup of hysterectomized women younger than 35 years old whereas in the other half of the same age category of patients the uterine adnexas were conserved. Among the study patients aged between 35 and 45 years in 50.5% of the cases the unilateral type of oophorectomy was undertaken while for the other 49.5% of women the bilateral adnexectomy was the rule. Finally, in all patients older than age 45 years the bilateral salpingo-oophorectomy was the procedure of choice. Moreover, out of the 55 study patients in which at least one ovary was preserved, 30.9% of cases underwent the removal of the remaining adnexa when affected de novo by malignant (n=3) or benign (n=14) pathology. Last but not least, in order to reduce both cancer risks and early menopause hazards, our analysis based on recent literature attempted to identify patient characteristics (relevant factors) associated with or without bilateral oophorectomy at the time of benign hysterectomy and to estimate modern trends in the performance of oophorectomy.

Conclusion: When considering options for treatment of benign conditions of the uterus both physicians and patients should ponder carefully the risk/benefit ratio of salpingo-oophorectomy according to each patient clinical profile.