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Outcomes of Risk-Reducing Bilateral Salpingectomy at Laparoscopic Hysterectomy for Benign Indications
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S24 Table 1 Baseline Patient Characteristics
Participants (n) Age (mean SD) Mean body-mass-index Median parity (range) Prior prolapse surgery, no. (%) Prior incontinence surgery, n (%) Smoking status No Yes, current Yes, quit Menopause SF-12 PCS MCS POP-Q stage, overall; median (range) 0 1 2 3 4
Standard counseling
Standard counseling + decision aid
50 60.3 11.1 27.7 5.8 2 (2-3) 9 (18%) 8 (16%) 30 0 20
53 61.0 13.2 27.7 5.5 2 (2-3) 5 (9.4%) 3 (5.7%) 34 2 17
37 (75.5%) 42 (79.2%) 46.1 12.4 45.0 49.1 11.9 46.6 12.4 11.3 2 (2-3) 0 (0%) 5 3 (2-3) 0 (0%) 3 (5.8%) 22 (10%) 27 (54%) 18 (36%) (42.3%) 26 0 (0%) (50%) 1 (1.9%)
ORAL PRESENTATION 05
Extension and Validation of Significant Linkage Evidence for Pelvic Organ Prolapse on Chromosome 10Q Allen-Brady K,1 Cannon-Albright L,1 Norton P.2 1Division of Genetic Epidemiology, Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah; 2OB/GYN, University of Utah, Salt Lake City, Utah Objectives: We previously reported significant linkage evidence for pelvic organ prolapse (POP) on chromosome 10q in 164 women who reported at least bothersome symptoms of POP. We continue to expand our Utah POP Genetic Resource with recruitment of new high-risk POP families and new POP cases in previously identified high-risk POP pedigrees. The objective of this study is to extend and validate the prior chromosome 10q linkage result with our expanded resource. Materials and methods: We assessed linkage evidence in 53 pedigrees with at least two women per pedigree who reported at least bothersome symptoms of POP. Bothersome symptoms were defined based on standardized symptom questions (Pelvic Floor Distress Inventory [PFDI]), (moderately or quite bothered), pelvic examination, and/or review of treatment records. The pedigrees ranged in size from 2 to 20 genotyped and affected individuals (n = 300 total genotyped subjects of whom 200 were affected); three of the pedigrees had 20 or more genotyped individuals. Genotype data were obtained from Illumina HumanHap550, 610Q, the Human1M-Duo, Human Omni1-Quad, or the Human Omni 2.5 platforms. We identified a set of single nucleotide polymorphism (SNP) markers common to all platforms and used this as our marker set. This set of markers was further pruned to derive a set of SNPs from which those in high linkage disequilibrium were eliminated. Parametric linkage analysis using a general dominant and recessive model was performed using the Markov Chain, Monte Carlo linkage analysis method (MCLINK). Results are reported as heterogeneity logarithm of odds scores (HLODs), where suggestive evidence is a score of 1.86 or higher and significant evidence is a score of 3.3 or higher. Results: There were 45 affected individuals with only bothersome POP symptoms, 111 subjects who had been surgically treated, and 44 subjects who required repeat surgical intervention. Significant genome-wide linkage evidence was again found on chromosome 10q24-26 with a maximum HLOD score of 4.21 under a recessive model. There were 29 pedigrees (54.7%) that had at least nominal linkage evidence (p \ 0.05) in this region, including two pedigrees with an HLOD score over 2.0 by themselves. Conclusion: Further study of the two extended high-risk POP families with suggestive linkage evidence of POP by themselves (i.e., HLOD
S3
>1.86) may provide insight into genes contributing to POP. Continued expansion of the Utah POP Genetic Resource has resulted in validation of the chromosome 10q region as a region of interest for a genetic contribution to POP. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Kristina Allen-Brady: Nothing to disclose Lisa Cannon-Albright: Nothing to disclose Peggy Norton: Nothing to disclose
ORAL PRESENTATION 06
Outcomes of Risk-Reducing Bilateral Salpingectomy at Laparoscopic Hysterectomy for Benign Indications Hou H, Pollard RR, Kane SM. Obstetrics and Gynecology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio Objectives: Prophylactic salpingectomies were first supported for BRCA mutation carriers. More recent evidence has shown that fallopian tubes also give rise to serious intraepithelial carcinomas in non-mutation carriers. Ovarian conservation has become the standard of care since evidence of premature menopause leading to serious health consequences and increased mortality has been documented. Salpingectomy alone may be an alternative choice to confer some protection against pelvic cancers without exposing patients to any increased morbidity or mortality. Our objective was to measure the outcomes of risk-reducing prophylactic salpingectomy at the time of laparoscopic hysterectomy for benign indications. Materials and methods: A retrospective review of non-BRCA patients who have had bilateral salpingectomy at the time of hysterectomy was conducted. Laparoscopic hysterectomy cases between January 2010 and December 2012 were reviewed through a search of procedural codes utilizing the electronic medical record. Those who had laparoscopic hysterectomy with or without prophylactic salpingectomy were included. Demographics were collected as well as surgical indications, perioperative complications, operative times, blood loss, and postoperative pain scores. Menopausal symptoms and subsequent evaluations of ovarian failure were also recorded. These parameters were then compared for patients who underwent laparoscopic hysterectomy with or without bilateral salpingectomy. Results: A total of 374 laparoscopic hysterectomies were performed by a single surgeon from 2010-2012 with 159 of those procedures including prophylactic bilateral salpingectomy. The mean age of the salpingectomy patients was younger, at 43.1 vs. 45.2 (p = 0.003). Other demographics of insurance status, race, and weight did not differ significantly. There was no difference in BMI at 31.1 vs. 31.9 in the salpingectomy vs. TLH alone groups. The data for TLH with salpingectomy vs. TLH alone for EBL (68.2 mL vs. 77.2 mL, p = 0.47), VAS pain scores (4.8 vs. 4.7, p = 0.85), menopausal symptoms (4.7% vs. 6.4%, p = 0.49), perioperative or postoperative complications (7.7% vs. 9.6%, p = 0.51), or overnight admissions (62.6% vs. 56.1%, p = 0.21) did not differ significantly. There was no difference in menopausal symptoms or hormone levels consistent with menopause between the two groups at the 6 week follow-up visits. Conclusion: Prophylactic salpingectomy done at the time of laparoscopic hysterectomies does not add any operative morbidity. At 6 weeks following prophylactic salpingectomy, there is no increase in menopausal symptoms and no evidence of increased postoperative complications. In non-BRCA patients, prophylactic salpingectomy is a reasonable and safe measure to perform in hopes of decreased risk of cancer and future operative interventions. Further research on the long-term cancer risk reduction is needed. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Huiying Hou: Nothing to disclose Robert R. Pollard: Nothing to disclose Sarah M. Kane: Nothing to disclose
Participants (n) Age (mean SD) Mean body-mass-index Median parity (range) Prior prolapse surgery, no. (%) Prior incontinence surgery, n (%) Smoking status No Yes, current Yes, quit Menopause SF-12 PCS MCS POP-Q stage, overall; median (range) 0 1 2 3 4
Standard counseling
Standard counseling + decision aid
50 60.3 11.1 27.7 5.8 2 (2-3) 9 (18%) 8 (16%) 30 0 20
53 61.0 13.2 27.7 5.5 2 (2-3) 5 (9.4%) 3 (5.7%) 34 2 17
37 (75.5%) 42 (79.2%) 46.1 12.4 45.0 49.1 11.9 46.6 12.4 11.3 2 (2-3) 0 (0%) 5 3 (2-3) 0 (0%) 3 (5.8%) 22 (10%) 27 (54%) 18 (36%) (42.3%) 26 0 (0%) (50%) 1 (1.9%)
ORAL PRESENTATION 05
Extension and Validation of Significant Linkage Evidence for Pelvic Organ Prolapse on Chromosome 10Q Allen-Brady K,1 Cannon-Albright L,1 Norton P.2 1Division of Genetic Epidemiology, Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah; 2OB/GYN, University of Utah, Salt Lake City, Utah Objectives: We previously reported significant linkage evidence for pelvic organ prolapse (POP) on chromosome 10q in 164 women who reported at least bothersome symptoms of POP. We continue to expand our Utah POP Genetic Resource with recruitment of new high-risk POP families and new POP cases in previously identified high-risk POP pedigrees. The objective of this study is to extend and validate the prior chromosome 10q linkage result with our expanded resource. Materials and methods: We assessed linkage evidence in 53 pedigrees with at least two women per pedigree who reported at least bothersome symptoms of POP. Bothersome symptoms were defined based on standardized symptom questions (Pelvic Floor Distress Inventory [PFDI]), (moderately or quite bothered), pelvic examination, and/or review of treatment records. The pedigrees ranged in size from 2 to 20 genotyped and affected individuals (n = 300 total genotyped subjects of whom 200 were affected); three of the pedigrees had 20 or more genotyped individuals. Genotype data were obtained from Illumina HumanHap550, 610Q, the Human1M-Duo, Human Omni1-Quad, or the Human Omni 2.5 platforms. We identified a set of single nucleotide polymorphism (SNP) markers common to all platforms and used this as our marker set. This set of markers was further pruned to derive a set of SNPs from which those in high linkage disequilibrium were eliminated. Parametric linkage analysis using a general dominant and recessive model was performed using the Markov Chain, Monte Carlo linkage analysis method (MCLINK). Results are reported as heterogeneity logarithm of odds scores (HLODs), where suggestive evidence is a score of 1.86 or higher and significant evidence is a score of 3.3 or higher. Results: There were 45 affected individuals with only bothersome POP symptoms, 111 subjects who had been surgically treated, and 44 subjects who required repeat surgical intervention. Significant genome-wide linkage evidence was again found on chromosome 10q24-26 with a maximum HLOD score of 4.21 under a recessive model. There were 29 pedigrees (54.7%) that had at least nominal linkage evidence (p \ 0.05) in this region, including two pedigrees with an HLOD score over 2.0 by themselves. Conclusion: Further study of the two extended high-risk POP families with suggestive linkage evidence of POP by themselves (i.e., HLOD
S3
>1.86) may provide insight into genes contributing to POP. Continued expansion of the Utah POP Genetic Resource has resulted in validation of the chromosome 10q region as a region of interest for a genetic contribution to POP. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Kristina Allen-Brady: Nothing to disclose Lisa Cannon-Albright: Nothing to disclose Peggy Norton: Nothing to disclose
ORAL PRESENTATION 06
Outcomes of Risk-Reducing Bilateral Salpingectomy at Laparoscopic Hysterectomy for Benign Indications Hou H, Pollard RR, Kane SM. Obstetrics and Gynecology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio Objectives: Prophylactic salpingectomies were first supported for BRCA mutation carriers. More recent evidence has shown that fallopian tubes also give rise to serious intraepithelial carcinomas in non-mutation carriers. Ovarian conservation has become the standard of care since evidence of premature menopause leading to serious health consequences and increased mortality has been documented. Salpingectomy alone may be an alternative choice to confer some protection against pelvic cancers without exposing patients to any increased morbidity or mortality. Our objective was to measure the outcomes of risk-reducing prophylactic salpingectomy at the time of laparoscopic hysterectomy for benign indications. Materials and methods: A retrospective review of non-BRCA patients who have had bilateral salpingectomy at the time of hysterectomy was conducted. Laparoscopic hysterectomy cases between January 2010 and December 2012 were reviewed through a search of procedural codes utilizing the electronic medical record. Those who had laparoscopic hysterectomy with or without prophylactic salpingectomy were included. Demographics were collected as well as surgical indications, perioperative complications, operative times, blood loss, and postoperative pain scores. Menopausal symptoms and subsequent evaluations of ovarian failure were also recorded. These parameters were then compared for patients who underwent laparoscopic hysterectomy with or without bilateral salpingectomy. Results: A total of 374 laparoscopic hysterectomies were performed by a single surgeon from 2010-2012 with 159 of those procedures including prophylactic bilateral salpingectomy. The mean age of the salpingectomy patients was younger, at 43.1 vs. 45.2 (p = 0.003). Other demographics of insurance status, race, and weight did not differ significantly. There was no difference in BMI at 31.1 vs. 31.9 in the salpingectomy vs. TLH alone groups. The data for TLH with salpingectomy vs. TLH alone for EBL (68.2 mL vs. 77.2 mL, p = 0.47), VAS pain scores (4.8 vs. 4.7, p = 0.85), menopausal symptoms (4.7% vs. 6.4%, p = 0.49), perioperative or postoperative complications (7.7% vs. 9.6%, p = 0.51), or overnight admissions (62.6% vs. 56.1%, p = 0.21) did not differ significantly. There was no difference in menopausal symptoms or hormone levels consistent with menopause between the two groups at the 6 week follow-up visits. Conclusion: Prophylactic salpingectomy done at the time of laparoscopic hysterectomies does not add any operative morbidity. At 6 weeks following prophylactic salpingectomy, there is no increase in menopausal symptoms and no evidence of increased postoperative complications. In non-BRCA patients, prophylactic salpingectomy is a reasonable and safe measure to perform in hopes of decreased risk of cancer and future operative interventions. Further research on the long-term cancer risk reduction is needed. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Huiying Hou: Nothing to disclose Robert R. Pollard: Nothing to disclose Sarah M. Kane: Nothing to disclose