Oophorectomy

ALSO KNOWN AS: Ovariotomy, ovariectomy, bilateral oophorectomy, preventive or prophylactic bilateral oophorectomy (PBO), prophylactic oophorectomy, laparoscopic oophorectomy

DEFINITION: Oophorectomy is the surgical removal of both ovaries as a treatment for ovarian cancer or metastasized cancer. The two ovaries are the part of the female reproductive system that produces egg cells (ova) and releases hormones, including estrogen. Both ovaries may be removed as a preventive measure for women with a high risk of ovarian cancer or breast cancer. Oophorectomy may be used for patients with estrogen-sensitive breast cancer to prevent its recurrence.

Cancers treated:Ovarian cancer, metastasized cancer, preventive treatment for patients at high risk for ovarian or breast cancer, treatment for estrogen-sensitive breast cancer

Why performed: Both ovaries are removed with an oophorectomy to help treat ovarian cancer. Most ovarian cancers develop in the epithelial cells that cover the outside of the ovary. Ovarian cancer can also develop in the germ cells (the cells that produce eggs) or in the stromal cells (the cells inside the ovary that produce estrogen and progesterone).

Ovarian cancer can spread to other parts of the body. Other parts of the female reproductive system, such as the Fallopian tubes, which transport eggs to the uterus for fertilization, may be removed in a surgery termed a bilateral salpingo-oophorectomy. Oophorectomy is used to treat metastasized cancer that originated elsewhere in the body and has spread to the ovaries.

Women with the BRCA1 or BRCA2 gene mutations have a high risk for breast cancer and gynecologic cancer. A preventive bilateral oophorectomy (PBO) is used to remove both ovaries of women with a family history and high risk of ovarian cancer. A PBO is usually performed after a woman has experienced childbirth or at about the age of thirty-five. Research has shown that PBO does reduce the risk of ovarian cancer for high-risk women.

Research shows that PBO before the age of forty can significantly reduce the risk of breast cancer for women with the BRCA1 or BRCA2 gene mutations. Oophorectomy may also be used as a preventive treatment for premenopausal women with estrogen-sensitive breast cancer. Removing both ovaries removes the primary source of estrogen in the body and can help to prevent estrogen-sensitive cancer cells from growing.

Patient preparation: Patients receive laboratory and blood tests before surgery. X-rays or ultrasound images may be taken to help plan the procedure. Patients should eat a light dinner and not eat or drink after midnight on the day of the surgery. In some cases, preparations may be used to empty the colon.

Steps of the procedure: Oophorectomy for the treatment of cancer uses general anesthesia and an open surgical method. A vertical is made on the abdomen. The abdominal muscles are spread apart to allow the surgeon access to the ovaries. The vertical incision allows the surgeon to view the abdominal cavity for disease or cancer. After both ovaries are removed, the incision is closed and bandaged.

A horizontal incision may be used to remove both ovaries if cancer is not present. A horizontal incision is associated with less scarring and bleeding. A laparoscopic oophorectomy may also be used if cancer is not present in cases of preventive surgery.

Laparoscopic oophorectomy is guided by images produced by a laparoscope, a narrow tube with a light, a viewing instrument, and a miniature camera. The laparoscope is inserted through small incisions in the abdomen. Surgical instruments are inserted through the laparoscope to remove the ovaries. Because laparoscopic surgery is minimally invasive and uses only small incisions, it is associated with less pain, less bleeding, fewer complications or infections, a shorter hospital stay, and a quicker recovery time. Robotic-assisted oophorectomy has also come into use as a minimally-invasive procedure with fewer complications and shorter recovery times.

After the procedure: The patient remains in the hospital for three to five days and returns to regular activity levels in about six weeks. Patients receiving open surgery may experience discomfort from having the abdominal muscles moved during the procedure. Patients receiving laparoscopic surgery may remain in the hospital for a night or two and resume regular activities sooner.

Patients who have both ovaries removed are no longer able to become pregnant and, therefore, experience “surgical menopause.” Those without cancer may receive hormones to help ease the risk of medical complications and menopausal symptoms. Symptoms of menopause may be more significant in women experiencing surgical menopause than in women with naturally occurring menopause. Further, women who underwent PBO were also more likely to develop arthritis, sleep apnea, and bone fractures.

Patients with ovarian cancer usually receive chemotherapy following oophorectomy. Chemotherapy uses medication, or a combination of medications, delivered over a period of time to help kill any remaining cancer cells. Radiation therapy is rarely used.

Risks: The surgical risks of oophorectomy include infection, bleeding, blood clots, and damage to other organs. Some women experience decreased sex drive and decreased orgasm. Bilateral oophorectomy increases the risk of cardiovascular disease, osteoporosis, and thyroid cancer. Hormone therapy can help reduce the risk. A study published in June 2024 revealed that women under the age of forty who underwent PBO had an increased incidence of dementia. This study highlighted the need for increased study into hormone replacement therapy following the procedure.

Results: Normal results are removal of both ovaries without complications and no findings of cancer. Abnormal results include the removal of both ovaries with findings of cancer, metastasized spread, or complications.

Bibliography

Fader, Amanda Nickles., and Peter. G. Rose. “Role of Surgery in Ovarian Carcinoma.” Journal of Clinical Oncology, vol. 25.20, 2007, pp. 2873–83.

Finch, Amy P. M., et al. "Impact of Oophorectomy on Cancer Incidence and Mortality in Women with a BRCA1 or BRCA2 Mutation." Journal of Clinical Oncology, vol. 32.15, 2014, pp. 1547–53.

Kauff, Noah D., and Richard R. Barakat. “Risk-Reducing Salpingo-Oophorectomy in Patients with Germline Mutations in BRCA1 or BRCA2.” Journal of Clinical Oncology, vol. 25.20, 2007, pp. 2921–27.

McCarthy, Anne Marie, et al. "Bilateral Oophorectomy, Body Mass Index, and Mortality in U.S. Women Aged 40 Years and Older." Cancer Prevention Research, vol. 5.6, 2012, pp. 847–54.

Obermair, Andreas. "The Impact of Risk-Reducing Hysterectomy and Bilateral Salpingo-Oophorectomy on Survival in Patients with a History of Breast Cancer—A Population-Based Data Linkage Study." International Journal of Cancer, vol. 134.9, 2014, pp. 2211–22.

“Oophorectomy: Purpose, Surgery, Risks & Recovery.” Cleveland Clinic, my.clevelandclinic.org/health/treatments/17800-oophorectomy. Accessed 27 June 2024.

Parker, William H., et al. “Elective Oophorectomy in the Gynecological Patient: When Is It Desirable?” Current Opinion in Obstetrics and Gynecology, vol. 19.4, 2007, pp. 350–54.

“Removal of Ovaries before Menopause Associated with Reduced White Matter in Brain.” EurekAlert!, 20 June 2024, www.eurekalert.org/news-releases/1048636. Accessed 27 June 2024.

Salamon, Maureen, and Toni Golen. “Ovary Removal before Menopause may Pose Health Risks.” Harvard Health, 1 Feb. 2024, www.health.harvard.edu/womens-health/ovary-removal-before-menopause-may-pose-health-risks. Accessed 27 June 2024.