A case series of 23 risk-reducing salpingo-oophorectomy and literature review

Abstract

遺伝性乳がん卵巣がん（HBOC）におけるリスク低減卵管卵巣摘出術（RRSO）は現在のところ卵巣癌、卵管癌に対する最も有効な手段である。2020年4月の保険収載以降、当院で施行したRRSO 23 例について臨床的検討をおこなったので報告する。 RRSO施行年齢は中央値47歳（40－71歳）、婦人科初診より手術施行までの期間は中央値6ヶ月（2－168ヶ月）だった。手術は全て鏡視下に施行し、子宮全摘を併施した症例は5例（22%）だったがリスク低減乳房切除術（RRM）を併施した症例はなかった。SEE-FIMプロトコールにて評価した全例において病理所見ではBRCA1病的バリアント陽性の2例（9%）に漿液性上皮内癌（STIC）を認め、また別の1例において術後16ヶ月時に腹膜がんの発症を認めた。 RRSOは当院でも安全に施行できていると思われるが、STIC症例の取り扱い、腹膜がんサーベイランス方法、子宮全摘やRRMとの併施手術など検討課題は多く、今後も症例の集積と多施設での協議が重要である。Currently, risk-reducing salpingo-oophorectomy (RRSO) for ovarian and fallopian tube cancers in hereditary breast-ovarian cancer syndrome is the most effective treatment option. We clinically reviewed and reported 23 RRSO cases performed at our hospital in April 2020. The median age of patients who underwent RRSO was 47 (40–71) years and median time from initial gynecological consultation to surgery was 6 months (2–168 months). All surgeries were laparoscopic. Five patients underwent total laparoscopic hysterectomy with RRSO, but none underwent concomitant risk-reducing mastectomy (RRM). All patients underwent pathologic examination according to the SEE-FIM protocol, and serous intraepithelial carcinoma (STIC) was found in two patients (9%) with positive BRCA1 pathologic mutations. One case developed primary peritoneal cancer 16 months postoperatively. Although RRSO may be performed safely at our hospital, there are many points to consider, such as the handling of STIC cases, surveillance methods for peritoneal cancer, and combination with total hysterectomy and RRM. Moreover, continuously accumulating cases and conducting multicenter studies are important