Journal of Ovarian Research May 15th: Tubal ligation, hysterectomy and ovarian cancer: A meta-analysis

 Blogger's Note: included in the study are references to hereditary ovarian cancer - BRCA's but not Lynch Syndrome
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Journal of Ovarian Research Tubal ligation, hysterectomy and ovarian cancer: A meta-analysis

Introduction
Ovarian cancer is the fifth leading cause of cancer death in US women [1], yet primary prevention recommendations are limited. Gynecological surgeries including tubal ligation and hysterectomy may alter ovarian cancer risk by protecting the ovary from ascending carcinogens or damaging the utero-ovarian artery altering hormonal function. In addition, tubal ligation may increase immunity against the surface glycoprotein human mucin 1 (MUC1) [2-4]. While tubal ligation and hysterectomy generally have been found to be inversely associated with ovarian cancer, effect estimates vary between studies and little is
known about potential effect modifiers of these associations. Therefore, we conducted a meta-analysis of the association between ovarian cancer and tubal ligation as well as hysterectomy.

Results
......In secondary analyses, the association between tubal ligation and ovarian cancer risk was stronger for endometrioid tumors compared to serous tumors.

Conclusion

Observational epidemiologic evidence strongly supports that tubal ligation and hysterectomy are associated with a decrease in the risk of ovarian cancer, by approximately 26-30%. Additional research is needed to determine whether the association between tubal ligation and hysterectomy on ovarian cancer risk differs by individual, surgical, and tumor characteristics.

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abstract: The effect of hysterectomy on survival of patients with borderline ovarian tumors (repost)

The effect of hysterectomy on survival of patients with borderline ovarian tumor

Objective
The classically recommended surgical treatment of borderline ovarian tumors (BOTs) includes hysterectomy in addition to bilateral adnexectomy. Possible reasons for hysterectomy might be a high frequency of uterine involvement and its favorable effect on survival. The purpose of the present study was to assess the frequency of uterine involvement in patients with BOTs and the effect of hysterectomy on survival.

Methods
All incident cases of histological confirmed BOTs diagnosed in Israeli Jewish women between March 1 1994 and June 30 1999, were identified. Clinical and pathological characteristics were abstracted from medical records. Patients with tumors grossly confined to the ovaries (apparently stage I) were considered to have had surgical staging when at least hysterectomy, bilateral salpingooophorectomy, omentectomy and pelvic lymph node sampling were done.

Results 
The study group comprised 225 patients. Hysterectomy was performed in 147 (65.31%) patients and uterine involvement was present in only 3 (2.0%) of them. The 13 year survival of the total group of patients was 85.8% and of those in apparent stage I, 88.5%. Among patients with tumors apparently confined to the ovaries, no significant survival difference was observed between unstaged and surgically staged patients. There was also no survival difference between the overall staged and unstaged patients and between patients in stages II–III who did and did not undergo hysterectomy.

Conclusions 
Our data indicate that the rate of uterine involvement in BOT is low and that hysterectomy does not favorably affect survival. The necessity of hysterectomy in BOT patients is questioned.

abstract: Variation in thromboembolic complications among patients undergoing commonly performed cancer operations

Variation in thromboembolic complications among patients undergoing commonly performed cancer operations

Compared with breast cancer, the incidence of VTE ranged from a 1.31-fold increase in VTE associated with gastrectomy to a 2.68-fold increase associated with hysterectomy.

abstract: Lynch syndrome: clinical, pathological, and genetic insights (prophylactic surgery - female)

Lynch syndrome: clinical, pathological, and genetic insights:

Conclusions
Therefore, taking the risk reduction into account, extended surgery at the time of the first colon primary should at least
be discussed, if not recommended. Also, prophylactic hysterectomy and bilateral oophorectomy at the time of a colorectal primary
should be recommended if family planning has been completed.

abstract: The effect of hysterectomy on survival of patients with borderline ovarian tumors

Objective

The classically recommended surgical treatment of borderline ovarian tumors (BOTs) includes hysterectomy in addition to bilateral adnexectomy. Possible reasons for hysterectomy might be a high frequency of uterine involvement and its favorable effect on survival. The purpose of the present study was to assess the frequency of uterine involvement in patients with BOTs and the effect of hysterectomy on survival.

 Conclusions

Our data indicate that the rate of uterine involvement in BOT is low and that hysterectomy does not favorably affect survival. The necessity of hysterectomy in BOT patients is questioned.

(adverse event) abstract: Inadvertent cystotomy at laparoscopic hysterectomy – Sydney West Advanced Pelvic Surgery (SWAPS)

Conclusion: 
Inadvertent cystotomy is a recognised complication at hysterectomy. The rate in the SWAPS unit is comparable to that of other published series. Overall, there has been a decline in the rate of bladder injury, which appears attributable to more experience gained with an acquisition of increased skill levels and improved techniques.

JAMA full free access: Health Outcomes After Stopping Conjugated Equine Estrogens Among Postmenopausal Women With Prior Hysterectomy-randomized control trial

Health Outcomes After Stopping Conjugated
Equine Estrogens Among Postmenopausal
Women With Prior Hysterectomy

full free access: Health Outcomes After Stopping Conjugated Equine Estrogens Among Postmenopausal Women With Prior Hysterectomy, April 6, 2011— JAMA

video/text: Hysterectomy and Cardiovascular Disease: Conserve the Ovaries?

media - Ovarian cancer researchers request practice changes to protect against ovarian cancer: deaths could be reduced 50 percent over 20 years

"They are asking all BC gynecologists to change surgical practice to fully remove the fallopian tube when performing hysterectomy or tubal ligation. Current practice leaves the fallopian tube in place for many types of hysterectomy and tubal ligation. This is a matter of convention, not need."

Abstract: The age of ovarian failure following premenopausal hysterectomy with ovarian conservation

Compliance with estrogen hormone replacement therapy after oophorectomy: a prospective study -- Menopause International

Results. The median age of women at the time of hysterectomy was 42 (range 22–46) years

Does surgical volume influence short-term outcomes of laparoscopic hysterectomy?

CONCLUSION: In laparoscopic hysterectomy, increasing the surgical volume can reduce the operating time and the risk for conversion to laparotomy but not the rate of serious complications

Study Questions Benefits of Elective Removal of Ovaries During Hysterectomy

Note: this is not new news but has been reported over the past few years

PHILADELPHIA -- March 10, 2010 -- An article published in the March/April issue of The Journal of Minimally Invasive Gynecology suggests that bilateral oophorectomy may do more harm than good.

Radical hysterectomy during the transition period from traditional to nerve-sparing technique

Conclusions:"Although during the introductory period nerve-sparing technique brings about an improvement in voiding function, it prolongs the total operative time in comparison to traditional radical hysterectomy."

Should the ovaries be removed or retained at the time of hysterectomy for benign disease? Human Reproduction Update