Therapeutic strategies related to ovarectomy associated with histerectomy for benign conditions

A.D. Stănescu, R.M. Sima, D.O. Bălălău, L. Pleș

Rezumat: Introduction. Patients undergoing total hysterectomy for benign uterine pathology face a controversial decision of bilateral ovariectomy. Studies show that most patients feel incompletely informed about their therapeutic options. Material and methods. We have reviewed international medical databases with randomized studies, meta-analysis of current recommendations and trends regarding histerectomy for benign uterine pathology and associated ovariectomy. Results. Randomized studies that included patients in the last 15 years who underwent total hysterectomy for benign pathology showed a distinct approach regarding the annexes. A series of meta-analyzes in the United States reported a 3.6% yearly decline in bilateral annexectomy, from 49.7% in 2001 to 33.4% in 2011. It was standardized that patients with total hysterectomy benefit from bilateral pre-menopausal salpingectomy for ovarian neoplasm prophylaxy. Also, patients with familial risk of breast or ovarian neoplasia require bilateral anexectomy in premenopause. The therapeutic attitude is individualized in menopausal patients without genital neoplasm associated risk. Conclusions. It is recommended to conserve ovaries in premenopausal patients at low risk for ovarian or breast cancer to avoid cardiovascular and sexual dysfunction. For menopausal patients aged over 65 years, bilateral ovariectomy does not have benefits on cardiovascular disease, hip fracture or sexual function, which is why it is required to be associated with total hysterectomy.
Cuvinte cheie: bilateral adnexectomy,ovarian cancer, salpingectomy