Role of Routine Peritoneal Biopsies During Risk Reducing Salpingo-Oophorectomy (RRSO)

Abstract

Objective The objective of this retrospective study was to assess the role of routine peritoneal biopsies during risk reducing salpingo-oophorectomy (RRSO).

Methods Data of 204 women who underwent RRSO between January 1, 2014 and February 20, 2020 at Charité – Universitätsmedizin Berlin, Campus Mitte were retrospectively analyzed. RRSO was done according to the standard operating procedures of the German Consortium Hereditary Breast and Ovarian Cancer (GC-HBOC) with peritoneal washing and several peritoneal biopsies. Specimen collected during RRSO were analyzed using the protocol for Sectioning and Extensively Examining the FIMbria (SEE-FIM). Perioperative complications were classified using the Clavien-Dindo-Classification.

Results 147 women who underwent RRSO had peritoneal biopsies and pelvic washing, 44 women had none of that. 123 patients (64.4%) carried a pathologic variant in gBRCA1, 53 (27.7%) carried a pathologic variant in gBRCA2. Histopathological evaluation identified four patients (2.1%) with pathological findings. Neither peritoneal biopsies nor pelvic washings revealed additional information after histological examination. There was no statistically significant difference in complication rate between the two groups. The mean surgery time for RRSO without peritoneal biopsies was 64.3 minutes compared to 77.8 minutes with peritoneal biopsies. That shows a statistically significant prolongation of 16% (13.5 minutes, p = 0.0383).

Conclusions The routine use of peritoneal biopsies during RRSO does not improve detection of occult ovarian cancer or STIC but prolongs the operation time significantly. By omitting peritoneal biopsies in RRSO not only perioperative risks are diminished but also costs could be reduced by shortening of surgery time as well as decreased number of pathological samples.

Zusammenfassung

Zielsetzung Ziel dieser retrospektiven Studie war es, die Bedeutung von routinemäßig durchgeführten peritonealen Biopsien bei risikoreduzierenden Salpingo-Oophorektomien (RRSO) zu evaluieren.

Methoden Die Daten von 204 Frauen, die sich zwischen dem 1. Januar 2014 und dem 20. Februar 2020 an der Charité – Universitätsmedizin Berlin, Campus Mitte, einer RRSO unterzogen, wurden retrospektiv analysiert. Die RRSO-Eingriffe wurden entsprechend den Vorgaben des Deutschen Konsortiums Familiärer Brust- und Eierstockkrebs zusammen mit Peritoneallavagen und mehreren peritonealen Biopsien durchgeführt. Die entnommenen Proben wurde gemäß dem SEE-FIM-Protokoll (SEE-FIM: Sectioning and Extensively Examining the FIMbria) analysiert. Perioperative Komplikationen wurden mithilfe der Clavien-Dindo-Klassifikation erfasst.

Ergebnisse Bei 147 Frauen, die sich einer RRSO unterzogen, wurden peritoneale Biopsien entnommen bzw. eine Peritonealspülung durchgeführt. Bei 44 Frauen wurde nur eine RSSO durchgeführt. Bei 123 Patientinnen (64,4%) fand sich eine pathologische gBRCA1-Mutation, 53 (27,7%) hatten eine pathologische gBRCA2-Mutation. Bei der histopathologischen Untersuchung wurden pathologische Befunde bei 4 Patientinnen (2,1%) festgestellt. Weder peritoneale Biopsien noch Bauchspülungen führten nach der histologischen Untersuchung zu weiteren Befunden. Es gab keinen statistisch signifikanten Unterschied zwischen beiden Gruppen in Bezug auf die Komplikationsraten. Die durchschnittliche Operationszeit für eine RRSO ohne peritoneale Biopsie betrug 64,3 Minuten verglichen mit 77,8 Minuten für eine RSSO mit peritonealer Biopsie. Das kam einer statistisch signifikanten Verlängerung der Operationszeit von 16% gleich (13,5 Minuten, p = 0,0383).

Schlussfolgerungen Die routinemäßige Durchführung von peritonealen Biopsien während einer RRSO führt nicht zu einer besseren Eierstockkrebs- oder STIC-Erkennungsrate, sondern nur zu einer signifikanten Verlängerung der Operationszeit. Werden keine peritoneale Biopsien bei der RSSO durchgeführt, verringern sich nicht nur die perioperativen Risiken, sondern auch die Kosten, da sich die Operationszeit verkürzt und die Anzahl der zur untersuchenden Proben verringert.

Key words

hereditary ovarian cancer - risk-reducing surgery - salpingo-oophorectomy - hereditary breast cancer - BRCA

Schlüsselwörter

erblicher Eierstockkrebs - risikoreduzierende Chirurgie - Salpingo-Oophorektomie - erblicher Brustkrebs - BRCA

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