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Prophylactic Oophorectomy

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101. Guidelines for the Evaluation and Treatment of Perimenopausal Depression

of recommendations. The preliminary guidelines were presented at the 2016 NAMS Annual Meeting and the 2017 World Congress on Women’s Mental Health, and feedback from those presentations was incorporated into final vetting of the guidelines, including the addition of a section on Specific Populations to address issues related to depression, hysterectomy with or without oophorectomy and primary ovarian insufficiency. The literature (English only) in each section was reviewed in a systematic manner for publications (...) . Additionally, the following two sections were added following feedback from NAMS, 4) Is hysterec- tomy with and without oophorectomy a risk factor for depres- sive symptoms/disorders? And 5) Is Premature Ovarian Insufficiency (POI) linked to depression? The section on the presentation of depression addressed: 1) Is there a unique or characteristic clinical presentation of depressive disorders during the menopause transition? 2) How is depression diagnosed during the menopause transition? What

2018 The North American Menopause Society

102. Opportunistic Salpingectomy and Other Methods of Risk Reduction for Ovarian/Fallopian Tube/Peritoneal Cancer in the General Population

not been identified on the epithelial surface of the ovary (High). 3. The recent change to the International Federation of Gynecology and Obstetrics staging system for high-grade serous cancers in 2014 included ovary, fallopian tube, and primary peritoneum together as primary sites of disease, reflecting the difficulty in distinguishing the location in which the cancer developed (High). 4. Prophylactic bilateral salpingo-oophorectomy can reduce the risk of high-grade serous cancers by 80% to 90 (...) % for breast cancer mutation carriers (High). 5. In women with breast cancer mutations, 5% to 6% of fallopian tubes from prophylactic salpingo-oophorectomies have serous tubal intraepithelial carcinomas present (High). 6. Serous tubal intraepithelial carcinomas are found most commonly at the fimbriated end of the fallopian tube and have p53 mutation changes identical to associated cancers (High). 7. Clear cell and endometrioid carcinomas are now believed to originate from endometriotic lesions deposited

2017 Society of Obstetricians and Gynaecologists of Canada

103. ASRM position statement on uterus transplantation: a committee opinion

treatment team Willing and able to follow infection prophylaxis protocols associated with solid-organ immunosuppression practice, including but not limited to cytomegalovirus and pneumocystis pneumonia prophylaxis History of hypertension, diabetes, or signi?cant systemic illness, including serious abnormalities of the heart, liver, kidney, hematologic, or central nervous system Any medical diagnosis placing the subject at high risk of surgical complications based on the transplantation team's review (...) and assessment Procedural risks associated with pelvic surgery Undue pressure to donate Possible ‘‘donor guilt’’ if unsuccessful Potential risks with older uteri/vascular grafts Use of ovarian vessels may require oophorectomy Deceased No donor risks Grafts from younger-aged donors Greater variety of vascular pedicles available, including ovarian vessels Limited preoperative assessment Scarcity of suitable organs and inconvenient scheduling/geography Possible dif?culties in obtaining consent from

2018 Society for Assisted Reproductive Technology

104. Guideline on the Diagnosis, Treatment, and Follow-up of Patients with Endometrial Cancer

. Effect of short-term hormone replacement therapy on breast cancer risk reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers: thePROSEStudyGroup.JClinOncol2005;23:7804–7810 29 Madalinska JB et al. The impact of hormone replacement therapy on menopausalsymptomsinyoungerhigh-riskwomenafterprophylactic salpingo-oophorectomy.JClinOncol2006;24:3576–3582 30 ParkerWHetal.Ovarianconservationatthetimeofhysterectomyand long (...) IQWIG. Positronenemissionstomographie (PET) und PET/CT bei Ovari- 22 Torizuka T et al. Ovarian cancer recurrence: role of whole-body posi- tron emission tomography using 2-[fluorine-18]-fluoro-2-deoxy-D- glucose.EurJNuclMedMolImaging2002;29:797–803 23 Takekuma M et al. Positron emission tomography with 18F-fluoro-2- deoxyglucose for the detection of recurrent ovarian cancer. Int J Clin Oncol2005;10:177–181 24 Rebbeck TR et al. Prophylactic oophorectomy in carriers

2018 German Guideline Program in Oncology

106. Hereditary Gastrointestinal Cancers: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

-oophorectomy reduce the incidence of EC and ovarian cancer in the LS population, although the survival benefit has not been demonstrated [29]. We recommend an annual gynaecological examination, TV US with cancer antigen 125 (CA 125) analysis and endometrial biopsy from age 30–35 years [IV, C]. Prophylactic hysterectomy with bilateral oophorectomy is an option that might be discussed and considered for mutation carriers who have completed childbearing or are postmenopausal [IV, C]. Urinary tract (...) ultrasound (EUS) surveillance in individuals with LS and one first-degree relative (FDR) affected with PC may be considered, although more supporting evidence is needed [IV, C] [28]. Gynaecological surveillance Transvaginal ultrasound (TV US) has shown poor sensitivity and specificity for the diagnosis of EC in women with LS, while endometrial sampling could identify patients with premalignant endometrial lesions or asymptomatic endometrial carcinomas. Prophylactic hysterectomy and/or bilateral salpingo

2019 European Society for Medical Oncology

107. ESMO–ESGO Consensus Conference Recommendations on Ovarian Cancer: Pathology and Molecular Biology, Early and Advanced Stages, Borderline Tumours and Recurrent Disease

, serous tubal intraepithelial carcinoma (STIC). While STIC is reported to be present in 11%–61% of HGSC cases, reports on low-stage and optimally examined cases clearly demonstrate that virtually all contain STIC or small microscopic tubal HGSC [8–11]. These studies also show that examples of single-site disease are always tubal and never ovarian. Furthermore, while ovarian in- volvement in HGSC is typically bilateral, as is common in me- tastasis to a paired organ, tubal involvement is unilateral (...) . Recommendation 1.1: a large majority of extrauterine HGSCs arise in the fallopian tube from STIC. SEE-FIM sectioning of both fallopian tubes should be carried out in all cases of extra- uterine HGSC where the tubes are grossly normal, and also in risk-reducing prophylactic surgery specimens. Level of evidence: III Strength of recommendation: A Consensus: 100% (40) yes, 0% (0) no, 0% (0) abstain (40 voters) Recommendation1.2: extrauterine HGSC can only be assigned as ovarian in origin if both fallopian tubes

2019 European Society for Medical Oncology

108. Proposals for a further expansion of day surgery in Belgium

) (85.21, 85.35) v v v v Mastectomy 85.4 v v Bilateral breast reduction 85.32 v Ligation/stripping of varicose veins 38.5 v v v Carpal tunnel release 04.43 v v Dupuytren’s contracture 82.35 v v Hip replacement 81.51-81.53 v Knee replacement 81.54-81.55 v Cruciate ligament repair 81.43, 81.45 v Disc operations 80.5 v Knee arthroscopy 80.26 v v v Baker’s cyst 83.39 v Arthroscopic meniscus 80.6 v Removal of bone implants 78.6 v v Repair of deformities on foot 77.51-77.59 v ICD-9-CM: International

2017 Belgian Health Care Knowledge Centre

109. Surgical Treatment of Patients With Lynch Syndrome

is the optimal strategy. 28 h owever, there are major limitations in the assumptions made, and the decision about the proper strategy must also take into account other factors than cost-effectiveness, most nota- bly patient preference. n o clear specific age recommenda- tion can be made based on the evidence. Because of the clear benefit of prophylactic surgery independent of col- ectomy, it is reasonable to offer hysterectomy and bilateral salpingo-oophorectomy to all women who are having a colon resection (...) . Hysterectomy and bilateral salpingo-oophorectomy should be offered to women with Lynch syndrome un- dergoing colectomy, particularly if they have finished childbearing. Strong recommendation based on moder- ate-quality evidence. 1B t he 2014 l ynch syndrome guidelines by the us m ulti- society task force on Colorectal Cancer, which were reviewed by the a merican s ociety of Colon and Rectal s ur- geons, recommended hysterectomy and bilateral salpingo- oophorectomy in all women over age 40 years or who have

2017 American Society of Colon and Rectal Surgeons

110. Treatment of Colon Cancer

abnormal ovaries or contiguous extension of the colon cancer, but routine prophylactic oophorectomy is not neces- sary. Grade of Recommendation: Strong recommen- dation based on low-quality evidence, 1C. In women with colon cancer who have normal ovaries and have average risk for ovarian cancer, prophylactic oopho- rectomy is not recommended. Alternatively, prophylactic oophorectomy should be considered when there are other risk factors for ovarian pathology such as HNPCC or BRCA and in postmenopausal (...) woman. The ovaries are the site for colorectal cancer metastasis (Krukenberg tumor) in 3% to 8% of patients. 149 Oophorectomy is recommended in pa- tients with suspected or confirmed ovarian metastasis, ei- ther by direct extension or metastasis. If 1 ovary is involved with metastatic disease, a bilateral oophorectomy should be performed with the expectation of prolonged survival in af- fected women who receive adjuvant chemotherapy. 149,150 3. The treatment of patients with isolated peritoneal

2017 American Society of Colon and Rectal Surgeons

111. 4th ESO?ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4)

of OFS/OFA, to which an additional endocrine agent should be added [1, 11]. The method for inducing OFS or OFA may vary due to patient’s preferences, logistical and ?nancial issues. Bilateral salpingo-oophorectomy by a minimal invasive approach is a rea- sonable option and should be discussed with patients. The con- ?rmation that ovarian function is adequately suppressed when chemically induced [i.e. luteinising hormone-releasing hormone (LHRH) agonist] is not always straightforward (...) recommenda- tions for care. Expert opinion/ n/a 100% AdequateOFSinthecontextofABC: Adequate OFS for ABC pre-menopausal patients can be obtained through bilat- eral ovariectomy, continuous use of LHRH agonists or OFA through pelvic RT (this latter is not always effective and therefore is the least preferred option). I/A 85% If a LHRH agonist is used in this age group, it should usually be given on a q4w basis to guarantee optimal OFS. II/B 85% Ef?cacy of OFS must be initially con?rmed analytically through

2018 European Society for Medical Oncology

113. Practice Bulletin: Hereditary Breast and Ovarian Cancer Syndrome

regulation), it is appropriate for women with mutations in BRCA1 or BRCA2 to use oral contra- ceptives if indicated, and use for cancer prophylaxis is reasonable. Although there have been conflicting reports in the literature on the effect of oral contraceptives on breast cancer risk (17), a recent meta-analysis showed no clear increased risk of breast cancer in BRCA mutation carriers who used oral contraceptives (57, 58). Surgical Risk Reduction Risk-Reducing Bilateral Salpingo- oophorectomy The most (...) 125 level may be reason- able for short-term surveillance in women at high risk of ovarian cancer starting at age 30–35 years until the time they choose to pursue risk-reducing bilateral salpingo- oophorectomy, which is the only proven intervention to reduce ovarian cancer-specific mortality (17). Available screening procedures (measurement of serum CA 125 level and transvaginal ultrasonography) have not been proved to decrease the mortality rate or increase the survival rate associated

2017 Society of Gynecologic Oncology

114. Interventions to Address Sexual Problems in People With Cancer

to hormonal therapy among men), this can lead to nonadherence or even discontinuation of cancer therapy. Providing information about and, as needed, relief from these (eg, pain medication for use with aromatase inhibitors) can improve sexual function. In general, improved symptom management leads to improved sexual response. Patients at high risk of cancer who choose to undergo cancer risk–reducing surgeries, such as bilateral mastectomy and/or oophorectomy, may also experience an effect on sexual (...) functioning. Clinicians should be aware that while the target population of this guideline is people with cancer, the management strategies and support for patients undergoing prophylactic surgery should remain the same as outlined in this guideline. Overall Sexual Functioning and Satisfaction for Women Recommendation The Expert Panel noted that current recommendations did not address the important role of symptom management and its effect on the sexual response. Improved symptom management can

2017 American Society of Clinical Oncology Guidelines

115. Hormone Therapy in Primary Ovarian Insufficiency

reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol 2005;23:7804–10. [ ] [ ] Malone KE, Daling JR, Weiss NS. Oral contraceptives in relation to breast cancer. Epidemiol Rev 1993;15:80–97. [ ] Romieu I, Berlin JA, Colditz G. Oral contraceptives and breast cancer. Review and meta-analysis. Cancer 1990;66:2253–63. [ ] [ ] Thomas DB. Oral contraceptives and breast cancer: review of the epidemiologic literature. Contraception 1991;43 (...) , demonstrating a 20–30% increased risk of the disease in these postmenopausal HT users ( , ), these data are not generalizable to women with primary ovarian insufficiency. Women with primary ovarian insufficiency are much younger at the time of HT initiation and their baseline risk of breast cancer is significantly lower compared with women to whom HT is administered after natural menopause. Short-term exposure to HT in BRCA1 and BRCA2 carriers following risk-reducing bilateral salpingo-oophorectomy has

2017 American College of Obstetricians and Gynecologists

116. Choosing the Route of Hysterectomy for Benign Disease

hysterectomy was successful in 88% of cases in which it was planned ( ). Based on these studies and other studies that showed advantages of the vaginal approach to hysterectomy, a laparoscopic approach to hysterectomy does not need to supplant a vaginal approach in order to perform an opportunistic salpingectomy ( ). It should be noted that prophylactic bilateral salpingo-oophorectomy in the setting of a genetic mutation represents a different surgical circumstance. In contrast to elective salpingo (...) Gynaecol 1996;103:915–20. [ ] Sheth SS. The place of oophorectomy at vaginal hysterectomy. Br J Obstet Gynaecol 1991;98:662–6. [ ] Agostini A, Vejux N, Bretelle F, Collette E, De Lapparent T, Cravello L, et al. Value of laparoscopic assistance for vaginal hysterectomy with prophylactic bilateral oophorectomy. Am J Obstet Gynecol 2006;194:351–4. [ ] Robert M, Cenaiko D, Sepandj J, Iwanicki S. Success and complications of salpingectomy at the time of vaginal hysterectomy. J Minim Invasive Gynecol 2015;22

2017 American College of Obstetricians and Gynecologists

117. Ovarian Cancer Screening

tubes (fimbria), as initially suggested by histologic evaluation of specimens from BRCA mutation carriers who have undergone prophylactic salpingo-oophorectomy [3,5,6,8]. The average lifetime risk for developing ovarian cancer for a woman in the United States is approximately 1.3% [2]. Women with certain risk factors are known to be at increased risk, including presence of BRCA1 or BRCA2 mutations, strong family history (ie, first-degree relative, particularly if premenopausal at the time (...) on bilateral salpingo-oophorectomy [11]. By mathematically modeling the behavior of ovarian cancers in hypothetical populations of BRCA mutation carriers and average-risk patients, researchers have gained insight into their natural history and have investigated a potential role for screening [3,4]. Based on their findings, current screening tools are expected to have low effectiveness because of the tendency for small cancers to spread rapidly [3,4]. Brown and Palmer [3], when a Principal Author

2017 American College of Radiology

118. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer

cisplatin-based neoadjuvant chemotherapy and have non-organ confined (pT3/T4and/or N+) disease at cystectomy should be offered adjuvant cisplatin-based chemotherapy. (Moderate Recommendation; Evidence Level: Grade C) Radical Cystectomy Clinicians should offer radical cystectomy with bilateral pelvic lymphadenectomy for surgically eligible patients with resectable non-metastatic (M0) muscle-invasive bladder cancer. (Strong Recommendation; Evidence Level: Grade B) When performing a standard radical (...) cystectomy, ileal conduit, continent cutaneous, and orthotopic neobladder urinary diversions should all be discussed. (Clinical Principle) In patients receiving an orthotopic urinary diversion, clinicians must verify a negative urethral margin. (Clinical Principle) Perioperative Surgical Management Clinicians should attempt to optimize patient performance status in the perioperative setting. (Expert Opinion) Perioperative pharmacologic thromboembolic prophylaxis should be given to patients undergoing

2017 American Urological Association

119. The 2017 hormone therapy position statement of The North American Menopause Society

,andcognition,whichhave been shown in observational studies to be lessened by ET. 103 Unless contraindications are present, ET is indicated for women who have had a bilateral oophorectomy and are hypoestrogenictoreducetheriskforVVAanddyspareunia 104 and osteoporosis, 105 with observational data suggesting benefit on atherosclerosis and CVD, 106 and cognitive decline and dementia 107 Key points InwomenwithearlynaturalorsurgicalmenopauseorPOI, early initiation of ET, with endometrial protection if the uterus (...) be superiortooralcontraceptivetherapytorestoreormaintain bone mineral density (BMD). OOPHORECTOMY IN PREMENOPAUSAL WOMEN Thesurgicalremovalofbothovariesleadstoamuchmore abrupt loss of ovarian steroids than does natural menopause and includes the loss of estrogen, progesterone, and testos- terone. 100 Vasomotor symptoms as well as a variety of estrogen deficiency-related symptoms and diseases are more frequent and more severe after oophorectomy and can have a major effect on QOL 101,102 and potential AEs on the CV system,bone,mood,sexualhealth

2017 The North American Menopause Society

120. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline Full Text available with Trip Pro

of including a total hysterectomy and oophorectomy as part of gender-affirming surgery. (Ungraded Good Practice Statement) 5.0 Surgery for sex reassignment and gender confirmation 5.1. We recommend that a patient pursue genital gender-affirming surgery only after the MHP and the clinician responsible for endocrine transition therapy both agree that surgery is medically necessary and would benefit the patient’s overall health and/or well-being. (1 |⊕⊕○○) 5.2. We advise that clinicians approve genital gender

2017 Pediatric Endocrine Society

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