Long-term outcomes of hysterectomy with bilateral salpingo-oophorectomy: a systematic review and meta-analysis
Long-term outcomes of hysterectomy with bilateral salpingo-oophorectomy: a systematic review and meta-analysis
Objective: this study aimed to provide an up-to-date systematic review of “the long-term outcomes of bilateral salpingo-oophorectomy at the time of hysterectomy” and perform a meta-analysis for the reported associations.
Data Sources: our study updated a previous systematic review by searching the literature using PubMed, Web of Science, and Embase for publications between January 2015 and August 2022.
Study Eligibility Criteria: our study included studies of women who had a hysterectomy with bilateral salpingo-oophorectomy vs women who had a hysterectomy with ovarian conservation or no surgery.
Methods: the quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations. Adjusted hazard ratios were extracted and combined to obtain fixed effect estimates.
Results: compared with hysterectomy or no surgery, hysterectomy with bilateral salpingo-oophorectomy in young women was associated with decreased risk of breast cancer (hazard ratio, 0.78; 95% confidence interval, 0.73–0.84) but with an increased risk of colorectal cancer (hazard ratio, 1.27; 95% confidence interval, 1.10–1.47). In addition, it was associated with an increased risk of total cardiovascular diseases, coronary heart disease, and stroke with hazard ratios of 1.18 (95% confidence interval, 1.11–1.25), 1.17 (95% confidence interval, 1.10–1.25), and 1.20 (95% confidence interval, 1.10–1.31), respectively. Compared with no surgery, hysterectomy with bilateral salpingo-oophorectomy before the age of 50 years was associated with an increased risk of hyperlipidemia (hazard ratio, 1.44; 95% confidence interval, 1.25–1.65), diabetes mellitus (hazard ratio, 1.16; 95% confidence interval, 1.09–1.24), hypertension (hazard ratio, 1.13; 95% confidence interval, 1.06–1.20), dementia (hazard ratio, 1.70; 95% confidence interval, 1.07–2.69), and depression (hazard ratio, 1.39; 95% confidence interval, 1.22–1.60). The evidence on the association with all-cause mortality in young women showed substantial heterogeneity between the studies (I2=85%; P<.01).
Conclusion: hysterectomy with bilateral salpingo-oophorectomy was associated with multiple long-term outcomes. The benefits of the addition of bilateral salpingo-oophorectomy to hysterectomy should be balanced against the risks.
all-cause mortality, anxiety, bilateral salpingo-oophorectomy, cancer, cardiovascular diseases, dementia, depression, diabetes mellitus, hyperlipidemia, hypertension, hysterectomy, parkinsonism
44-57
Hassan, Hend
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Allen, Isaac
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Sofianopoulou, Eleni
58f9ab8c-87e5-4b7a-ad3b-4f85b89d2dad
Walburga, Yvonne
956bed58-8779-472d-9017-239f08b7d116
Turnbull, Clare
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Eccles, Diana M.
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Tischkowitz, Marc
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Pharoah, Paul
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Antoniou, Antonis C.
0d2a2298-34c0-49fd-bd8d-a14ec7daefb1
January 2024
Hassan, Hend
f6df8c3f-7aca-4f59-9bce-87f557b0cbeb
Allen, Isaac
6268ab30-a744-4c41-8ea5-51fdaf383a99
Sofianopoulou, Eleni
58f9ab8c-87e5-4b7a-ad3b-4f85b89d2dad
Walburga, Yvonne
956bed58-8779-472d-9017-239f08b7d116
Turnbull, Clare
11b8255e-4fee-407e-807e-59da6d67d8bc
Eccles, Diana M.
5b59bc73-11c9-4cf0-a9d5-7a8e523eee23
Tischkowitz, Marc
dde7a0ce-14a3-4171-8f9c-c3f4d0623735
Pharoah, Paul
903fe660-4f9d-4b09-8e90-cdc89e6f2c59
Antoniou, Antonis C.
0d2a2298-34c0-49fd-bd8d-a14ec7daefb1
Hassan, Hend, Allen, Isaac, Sofianopoulou, Eleni, Walburga, Yvonne, Turnbull, Clare, Eccles, Diana M., Tischkowitz, Marc, Pharoah, Paul and Antoniou, Antonis C.
(2024)
Long-term outcomes of hysterectomy with bilateral salpingo-oophorectomy: a systematic review and meta-analysis.
American Journal of Obstetrics and Gynecology, 230 (1), .
(doi:10.1016/j.ajog.2023.06.043).
Abstract
Objective: this study aimed to provide an up-to-date systematic review of “the long-term outcomes of bilateral salpingo-oophorectomy at the time of hysterectomy” and perform a meta-analysis for the reported associations.
Data Sources: our study updated a previous systematic review by searching the literature using PubMed, Web of Science, and Embase for publications between January 2015 and August 2022.
Study Eligibility Criteria: our study included studies of women who had a hysterectomy with bilateral salpingo-oophorectomy vs women who had a hysterectomy with ovarian conservation or no surgery.
Methods: the quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations. Adjusted hazard ratios were extracted and combined to obtain fixed effect estimates.
Results: compared with hysterectomy or no surgery, hysterectomy with bilateral salpingo-oophorectomy in young women was associated with decreased risk of breast cancer (hazard ratio, 0.78; 95% confidence interval, 0.73–0.84) but with an increased risk of colorectal cancer (hazard ratio, 1.27; 95% confidence interval, 1.10–1.47). In addition, it was associated with an increased risk of total cardiovascular diseases, coronary heart disease, and stroke with hazard ratios of 1.18 (95% confidence interval, 1.11–1.25), 1.17 (95% confidence interval, 1.10–1.25), and 1.20 (95% confidence interval, 1.10–1.31), respectively. Compared with no surgery, hysterectomy with bilateral salpingo-oophorectomy before the age of 50 years was associated with an increased risk of hyperlipidemia (hazard ratio, 1.44; 95% confidence interval, 1.25–1.65), diabetes mellitus (hazard ratio, 1.16; 95% confidence interval, 1.09–1.24), hypertension (hazard ratio, 1.13; 95% confidence interval, 1.06–1.20), dementia (hazard ratio, 1.70; 95% confidence interval, 1.07–2.69), and depression (hazard ratio, 1.39; 95% confidence interval, 1.22–1.60). The evidence on the association with all-cause mortality in young women showed substantial heterogeneity between the studies (I2=85%; P<.01).
Conclusion: hysterectomy with bilateral salpingo-oophorectomy was associated with multiple long-term outcomes. The benefits of the addition of bilateral salpingo-oophorectomy to hysterectomy should be balanced against the risks.
Text
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More information
Accepted/In Press date: 21 June 2023
e-pub ahead of print date: 24 June 2023
Published date: January 2024
Additional Information:
Funding Information:
This work was funded by the Cancer Research UK Catalyst Award CanGene-CanVar (grant number: C61296/A27223). M.T. was supported by the National Institutes of Health and Care Research Cambridge Biomedical Research Center (grant number: BRC-1215-20014 ).
Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.
Keywords:
all-cause mortality, anxiety, bilateral salpingo-oophorectomy, cancer, cardiovascular diseases, dementia, depression, diabetes mellitus, hyperlipidemia, hypertension, hysterectomy, parkinsonism
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Local EPrints ID: 482512
URI: http://eprints.soton.ac.uk/id/eprint/482512
ISSN: 0002-9378
PURE UUID: feff37c0-150d-4285-82a1-a57a8aa9e103
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Date deposited: 10 Oct 2023 16:39
Last modified: 24 Apr 2024 01:32
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Contributors
Author:
Hend Hassan
Author:
Isaac Allen
Author:
Eleni Sofianopoulou
Author:
Yvonne Walburga
Author:
Clare Turnbull
Author:
Marc Tischkowitz
Author:
Paul Pharoah
Author:
Antonis C. Antoniou
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