Surgical Approach to Risk-Reducing Salpingo-Oophorectomy in BRCA Mutation Carriers

295 Views | Sep 26, 2019

Authors: Elisabeth Spénard, Joannie Neveu, Béatrice Cormier, Thomas Warkus, Vanessa Samouëlian

Affliations: Université de Montréal

BRCA 1 and BRCA 2 account for 15-20% of all ovarian cancers. Risk-reducing salpingo-oophorectomy (RRSO) is the only proven method to decrease mortality in BRCA mutation carriers. No screening method has been shown to reduce mortality. The objectives of this video are to clarify the risk of ovarian cancer in women carrying a BRCA mutation, assess the advantages associated with minimally invasive RRSO and establish a step-by-step surgical approach to RRSO in BRCA carriers. The 5-Step RRSO approach includes: abdominal exploration, peritoneal washings, retro-peritoneum and ureter visualization, infundibulopelvic ligament dissection 2 cm away from the ovary as well as complete dissection of the fallopian tubes. With the increasing awareness of BRCA 1 and BRCA 2 gene mutations and genetic testing, more and more gynecologists will be faced with surgical management of patients with these mutations. Following the 5-Step RRSO approach will allow efficient and reproducible surgical management.