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. 2023 Feb 10;15(4):1141.
doi: 10.3390/cancers15041141.

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  1   2 , Fabrice Narducci  1   2 , Gwenaël Ferron  3 , Audrey Mailliez  4 , Jean-Yves Charvolin  5 , El Hajj Houssein  1 , Frédéric Guyon  6 , Virginie Fourchotte  7 , Eric Lambaudie  8 , Agathe Crouzet  9 , Yves Fouche  10 , Sébastien Gouy  11 , Pierre Collinet  12 , Frédéric Caquant  13 , Christophe Pomel  14 , François Golfier  15 , Véronique Vaini-Cowen  16 , Isabelle Fournier  2 , Michel Salzet  2 , Emmanuelle Tresch  17 , Alicia Probst  18 , Anne-Sophie Lemaire  19 , Marie-Cécile Le Deley  18   20 , Delphine Hudry  1   2
Affiliations

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 et al. Cancers (Basel). .

Abstract

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.

Keywords: delayed oophorectomy; early menopause; high risk of breast and ovarian cancer; ovarian cancer prevention; radical fimbriectomy; risk-reducing surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Participant flow.
Figure 2
Figure 2
Cumulative incidence of oophorectomy from radical fimbriectomy (N = 119).
Figure 3
Figure 3
Cumulative incidence of breast cancer from radical fimbriectomy in patients with no personal history of breast cancer (N = 52).
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