CASE Patient resubmits to surgery
In the case described at the beginning of this Editorial, the patient had her ovaries, but not her fallopian tubes, removed. Alone, bilateral oophorectomy decreased her risk of ovarian cancer and breast cancer (by curtailing production of ovarian hormones), but she remains at increased risk of fallopian tube and peritoneal carcinoma because she did not have her fallopian tubes removed. The patient is offered a second surgery to remove both fallopian tubes. She accepts this option.
What specific risk did the incomplete surgery pose to the patient? In 1 case series, among women at high risk of pelvic cancer, bilateral oophorectomy alone was associated with an 11.5% risk of peritoneal papillary serous carcinoma (PPSC) postoperatively. On the other hand, removing the ovaries and fallopian tubes was associated with no cases of PPSC.6
Most experts recommend that as much as possible of the fallopian tube be removed at surgery. Because most occult fallopian tube lesions have been reported in the fimbriated end of the tube, removing the interstitial portion is unnecessary. If surgical staging is indicated, it should be performed at surgery.