Published online Mar 28, 2015. doi: 10.5412/wjsp.v5.i1.167
Peer-review started: August 6, 2014
First decision: August 28, 2014
Revised: September 13, 2014
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: March 28, 2015
AIM: To appraise the current evidence for prophylactic oophorectomy in patients undergoing primary curative colorectal cancer resection.
METHODS: Occult ovarian metastases may lead to increased mortality, therefore prophylactic oophorectomy may be considered for women undergoing colorectal resection. A systematic review and meta-analysis was performed for English language studies from 1994 to 2014 (PROSPERO Registry number: CRD42014009340), comparing outcomes following prophylactic oophorectomy (no known ovarian or other metastatic disease at time of surgery) vs no ovarian surgery, synchronous with colorectal resection for malignancy. Outcomes assessed: local recurrence, 5-year mortality, immediate post-operative morbidity and mortality, and rate of distant metastases.
RESULTS: Final analysis included 4 studies from the United States, Europe and China, which included 627 patients (210 prophylactic oophorectomy and 417 non-oophorectomy). There was one randomized controlled trials, the remainder being non-randomised cohort studies. The studies were all at high risk of bias according to the Cochrane Collaboration’s assessment tool for randomised studies and the Newcastle-Ottawa Score for the cohort studies. The mean age of patients amongst the studies ranged from 56.5 to 67 years. There were no significant differences between the patients having prophylactic oophorectomy at time of primary colorectal resection compared with patients who did not with respect to local recurrence, 5-year survival and distant metastases. There was no difference in post-operative complications or immediate post-operative mortality between the groups.
CONCLUSION: Current evidence does not favour prophylactic oophorectomy for patients without known genetic predisposition. Prophylactic surgery is not associated with additional risk of post-operative complications or death.
Core tip: Prophylactic oophorectomy is a potentially attractive additional procedure that can be performed at the time of primary colorectal resection, to reduce the risk of ovarian metastasis and de novo ovarian malignancy later in a female patient’s clinical course. A systematic review and meta-analysis of the available literature reveals that, though this procedure can be performed with little additional morbidity or mortality risk at the time of surgery, it confers no long term survival benefit, and carries a significant side effect profile.