BJS Open

Impact of prophylactic bilateral salpingo-oophorectomy in patients with colorectal cancer with peritoneal metastasis during cytoreductive surgery: dual-center cohort analysis

Abstract Background Ovarian metastases are common in patients with colorectal cancer (CRC) with peritoneal metastases. For patients with bilateral macroscopically normal ovaries, prophylactic bilateral salpingo-oophorectomy (BSO) remains controversial. This study assessed the survival benefit of prophylactic BSO during cytoreductive surgery (CRS). Methods This retrospective cohort study included patients with CRC with peritoneal metastases who underwent CRS at two medical centres in southern China between 2017 and 2022. Patients achieving complete CRS with bilateral macroscopically normal ovaries were included in the subsequent analysis and divided into BSO and non-BSO groups. The primary outcomes of interest were the rates of synchronous and metachronous ovarian metastases. Clinical and surgical variables, including peritoneal carcinoma index (PCI) scores, were analysed for their correlation with these outcomes. Disease-free survival and overall survival were analysed using the Kaplan–Meier method, and prognostic variables were analysed using multivariate logistic regression. Results Of 237 consecutive patients who underwent CRS, 94 had macroscopically normal ovaries. Of these, 69 (29.1%) underwent complete CRS and were divided into two groups: 26 who underwent prophylactic BSO and 43 with organ preservation. In the BSO group, 7 patients (26.9%) had occult synchronous ovarian metastases. In the non-BSO group, 13 patients (30.2%) developed metachronous ovarian metastases, with 10 of these patients undergoing secondary surgery for ovarian metastases. Both synchronous and metachronous ovarian metastases were significantly associated with a higher PCI (P = 0.048). Premenopausal status was independently associated with metachronous ovarian metastases (hazard ratio 6.281; 95% confidence interval 1.364 to 28.922; P = 0.018). No significant differences were observed between the BSO and non-BSO groups in 2-year disease-free survival (P = 0.866) or overall survival (P = 0.557). Conclusion For patients with CRC with peritoneal metastasis and bilateral macroscopically normal ovaries, prophylactic BSO does not improve mid-term survival.

Ovarian cancer risk reduction by salpingectomy during non-gynaecological surgery: scoping review

Abstract Background Ovarian cancer is the leading cause of death among gynaecological cancers. The identification of the fallopian tube epithelium as the origin of most ovarian cancers introduces a novel prevention strategy by removing the fallopian tubes during an already indicated abdominal surgery for another reason, also known as an opportunistic salpingectomy. This preventive opportunity is evidence based, recommended and established at the time of gynaecologic surgery in many countries worldwide. To expand interest among surgeons in performing a salpingectomy during non-gynaecological surgery, the aim of this review is to identify knowledge gaps during those surgeries. Methods A scoping review was performed following the PRISMA-Scoping Review (ScR) checklist. PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) database and Cochrane Library were systematically searched from inception to November 2024. Trial registers were searched for ongoing trials. All studies reporting original data on salpingectomy during non-gynaecological surgery were included. Outcomes were provided narratively. Results Eighteen studies were identified reporting on the implementation, surgical feasibility, patients’ perspectives, physicians’ knowledge and cost-effectiveness of an opportunistic salpingectomy during non-gynaecological surgery. Population-level data indicate that an opportunistic salpingectomy is rarely performed in non-gynaecological surgeries. High success rates and no complications of an opportunistic salpingectomy were observed during bariatric surgery and cholecystectomies. However, performing an additional salpingectomy appeared more time-consuming. Patients had strong interest in information on and willingness to undergo opportunistic salpingectomy. Cost-effectiveness analysis encourages opportunistic salpingectomy use, as models show reduced ovarian cancer incidence and mortality rate while being cost-effective. Conclusions Opportunistic salpingectomy during non-gynaecologic surgery appears to be a promising method to prevent ovarian cancer. Implementing such a strategy will require education of multiple surgical disciplines, training and resolution of organizational issues.

Complications and adverse events in lymphadenectomy of the inguinal area: worldwide expert consensus

Abstract Background Inguinal lymph node dissection plays an important role in the management of melanoma, penile and vulval cancer. Inguinal lymph node dissection is associated with various intraoperative and postoperative complications with significant heterogeneity in classification and reporting. This lack of standardization challenges efforts to study and report inguinal lymph node dissection outcomes. The aim of this study was to devise a system to standardize the classification and reporting of inguinal lymph node dissection perioperative complications by creating a worldwide collaborative, the complications and adverse events in lymphadenectomy of the inguinal area (CALI) group. Methods A modified 3-round Delphi consensus approach surveyed a worldwide group of experts in inguinal lymph node dissection for melanoma, penile and vulval cancer. The group of experts included general surgeons, urologists and oncologists (gynaecological and surgical). The survey assessed expert agreement on inguinal lymph node dissection perioperative complications. Panel interrater agreement and consistency were assessed as the overall percentage agreement and Cronbach’s α. Results Forty-seven experienced consultants were enrolled: 26 (55.3%) urologists, 11 (23.4%) surgical oncologists, 6 (12.8%) general surgeons and 4 (8.5%) gynaecology oncologists. Based on their expertise, 31 (66%), 10 (21.3%) and 22 (46.8%) of the participants treat penile cancer, vulval cancer and melanoma using inguinal lymph node dissection respectively; 89.4% (42 of 47) agreed with the definitions and inclusion as part of the inguinal lymph node dissection intraoperative complication group, while 93.6% (44 of 47) agreed that postoperative complications should be subclassified into five macrocategories. Unanimous agreement (100%, 37 of 37) was achieved with the final standardized classification system for reporting inguinal lymph node dissection complications in melanoma, vulval cancer and penile cancer. Conclusion The complications and adverse events in lymphadenectomy of the inguinal area classification system has been developed as a tool to standardize the assessment and reporting of complications during inguinal lymph node dissection for the treatment of melanoma, vulval and penile cancer.