The following is a summary of “Adherence to risk-reducing salpingo-oophorectomy guidelines among gynecologic oncologists compared to general gynecologists,” published in the SEPTEMBER 2023 issue of Obstetrics and Gynecology by Blustein, et al.
Risk-reducing salpingo-oophorectomy (RRSO) is a surgical procedure that aims to reduce the risk of high-grade serous carcinoma, especially in individuals with hereditary breast and ovarian cancer gene mutations. In 2005, guidelines were established by the Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists to outline the ideal approach for RRSO. These guidelines emphasize the importance of comprehensive pathologic examination and include five recommended surgical steps. However, RRSO is performed by different healthcare providers, and their adherence to these guidelines can vary. For a study, researchers sought to assess how well healthcare providers adhere to the recommended surgical and pathologic examination guidelines for RRSO. Additionally, they aimed to compare the rate of discovering hidden malignancies during surgery between two distinct groups of healthcare providers.
To conduct the study, a retrospective analysis was carried out on patients who underwent RRSO without hysterectomy between October 1, 2015, and December 31, 2020, across three healthcare system sites. The study included individuals aged 18 or older with a documented reason for surgery, such as carrying BRCA1 or BRCA2 gene mutations or having a strong family history of breast and/or ovarian cancer. The evaluation of adherence to the guidelines relied on information documented in the patients’ medical records. Multivariable logistic regression was used to identify any variations in guideline compliance between the two groups of healthcare providers. The significance level was set at P<.025 for the two main outcomes to account for Bonferroni correction, which is necessary when making multiple comparisons.
The study examined a total of 185 patients. In surgeries conducted by gynecologic oncologists (96 cases), 72% followed all five recommended surgical steps, 23% adhered to four steps, and 5% complied with three steps. None of the surgeries adhered to only one or two steps. In contrast, among surgeries performed by general gynecologists (89 cases), only 5% followed all five steps, 37% observed four steps, 43% adhered to three steps, 15% carried out two, and 1% strictly followed one step. Gynecologic oncologists demonstrated significantly higher levels of documentation for adherence to all five surgical steps in their surgical records (odds ratio, 54.3; 95% CI, 18.1–162.7; P<.0001). When it came to pathologic examination, 43% of the cases documented by gynecologic oncologists included serial sectioning of all specimens. In contrast, only 26% of the cases performed by general gynecologists adopted this practice. Despite these differences in surgical practice, there wasn’t a significant variance in adherence to pathologic guidelines between the two groups of healthcare providers (P=.0489; note: P value of >.025). At the time of risk-reducing surgery, 5 patients (2.70%) had undetected cancer identified; general gynecologists carried out all procedures.
The study’s findings emphasized the notable differences in adherence to surgical guidelines for RRSO between gynecologic oncologists and general gynecologists. However, these two groups showed no significant contrast in adhering to pathologic guidelines. It underscored the importance of comprehensive, institution-wide educational efforts aimed at protocol adherence and implementing standardized terminology to ensure that all healthcare providers adhere to evidence-based RRSO guidelines.