Fig. 17.1
Midline incision. Dissected ovary with the pedicle is shown. Ovarian pedicle is dissected up to just beyond the pelvic brim. 1. Ovary. 2. Ovarian pedicle. 3. Appendix. 4. Sigmoid colon
Fig. 17.2
Ovary positioned in the anterior abdominal wall in a space created over the rectus sheath below the umbilicus. 1. Subcutaneous fat. 2. Ovary 3. Rectus sheath with peritoneum. 4. Ovarian pedicle. 5. Appendix. The pedicle is seen lateral to appendix
Conclusion
Most current literature shows that coexisting ovarian cancer is low and metastatic ovarian cancer is negligible in low-risk endometrial cancer. More evidence is accruing on the safety of ovarian conservation in hysterectomy. The decision to conserve or remove ovaries should be tailored to individual risks. When ovaries are preserved, salpingectomy is a good option. Placement of ovaries in the anterior abdominal wall appears to be a feasible choice.
Key Points
1.
Endometrial cancer is associated with synchronous ovarian malignancy in 5 % of women.
2.
In young women, the association of concurrent uterine and ovarian malignancy is high.
3.
There is a definite risk reduction in breast and ovarian cancer in women who have undergone prophylactic oophorectomy, but effect is negated by the increase in risk of all-cause mortality.
4.
Hysterectomy with or without ovarian conservation is not a key determinant of cardiovascular risk status either before or after elective surgery in midlife.
5.
Based on evidence, American Society of Obstetrics and Gynecology specified certain guidelines for the prophylactic oophorectomy.
6.
A Korean Gynecological Oncology group study concluded that ovarian preservation does not appear to have an adverse impact on recurrence and survival in premenopausal women with early stage endometrial cancer.
References
1.
Barakat RR, Bundy BN, Spirtos NM et al., Gynecologic Oncologic Group Study. Randomized double blind trial of estrogen replacement therapy versus placebo in stage 1 or 2 endometrial cancer: a gynecologic oncologic group study. J Clin Oncol. 2006;24:587–92.
2.
Zaino R, Whitney C, Brady M, et al. Simultaneously detected endometrial and ovarian carcinomas – a prospective clinicopathologic study of 74 cases: a gynecologic oncology group study. Gynecol Oncol. 2001;83:355–62.CrossRefPubMed
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