Laparoscopic Bilateral Salpingo-oophorectomy in Breast Cancer Patients after Transverse Rectus Abdominis Myocutaneous Flap Reconstructive Surgery

Synopsis:Laparoscopic RRSO is safe and feasible in patients who have undergone a prior TRAM flap reconstruction.

Source: Awtrey CS, et al. Laparoscopic bilateral salpingooophorectomy in breast cancer patients after transverse rectus abdominis myocutaneous flap reconstructive surgery. Gynecol Oncol. 2005;99:720-725.

It has become increasingly documented that removal of the ovaries in high-risk women can not only reduce the risk of gynecologic malignancy but also improve the outcome of women with breast cancer. Resection may be accomplished via laparoscopy or laparotomy; the former is preferred given the reduction in potential complications, shorter recovery, and improved cosmesis. However, laparoscopic removal of the adnexa in breast cancer patients who have had a reconstruction procedure involving a rectus flap can present a challenge both mechanically and anatomically. Awtrey and colleagues reviewed their experience of risk-reducing salpingo-oophorectomy (RRSO) over a 7-year period, dichotomizing the cohort on the basis of whether the procedure was performed in those with rectus muscle reconstruction (TRAM, n = 10) or without reconstruction (n = 92). No differences were noted with respect to patient demographics, body mass index, previous abdominal surgery, menopausal status, or preoperative ultrasound adnexal characteristics. Both cohorts appeared to be similar in operative outcome, post-operative stay, and complications. The only distinguishing variable was the duration of time to completion for those with a history of TRAM reconstruction. Satisfactory operative outcome in relationship to ovarian resection was similar. These data support the feasibility and safety of laparoscopic salpingo-oophorectomy in patients with a history of breast cancer, including those in whom TRAM reconstruction has been performed.