Screening for ovarian cancer is ineffective. Removing the tube and ovary and carefully inspecting for occult disease may be a better-and potentially lifesaving-option for high-risk mutation carriers.
[Detection of occult disease during risk-reducing salpingo-oophorectomy allows for treatment of earlier disease, and therefore could offer a better hope of cure to patients with ovarian cancer.] The other surgical option for BRCA1 and BRCA2 mutation carriers-hysterectomy-has been recommended by some groups but is not fully endorsed by all major organizations.8, 9
Performing risk-reducing salpingo-oophorectomy step by step
[Next, identify the ureter and open the retroperitoneal space. Isolate and divide the ovarian vessels.] To ensure that all ovarian tissue has been removed, we ligate the infundibulopelvic ligament 2 cm proximal to the end of the identifiable ovarian tissue. If adhesions are present, take great care to ensure that your resection is complete. If you are not also doing a hysterectomy on the patient, isolate the fallopian tube and divide it where it inserts into the uterine cornu, then isolate and divide the utero-ovarian ligaments.
[Before you remove the specimens from the peritoneal cavity, place them in an endoscopic bag to preserve as much of the ovarian surface epithelium as possible.] Intraoperative pathology review should include a close examination for possible occult disease. At our institution, this surgery is done by someone from the gynecologic oncology service, and our patient consent for this procedure includes the possibility of complete surgical staging at the time of surgery. If we find ovarian cancer during risk-reducing surgery, we proceed with surgical staging, including lymphadenectomy, omentectomy, and peritoneal biopsies.