title: Radical fimbriectomy: a reasonable temporary risk-reducing surgery for selected women with a germ line mutation of BRCA 1 or 2 genes? Rationale and preliminary development.
abstract: OBJECTIVE
  Bilateral salpingo-oophorectomy (BSO) is the gold standard prophylactic surgery for BRCA1 or 2 mutation carriers. However, due to the resulting early menopause and fertility desires, young women are reluctant to undergo this procedure. In view of the recent literature on ovarian carcinogenesis, we wish to report a novel conceptual surgical procedure we called "radical fimbriectomy." This procedure is aimed to protect this subset of high-risk women from high-grade serous pelvic carcinoma, while preserving their ovarian function.
  
  
  METHODS
  Women with BRCA mutation, who were scheduled for BSO, were informed of the procedure approved by our local review board. Radical fimbriectomy consists of removing all the tube and the fimbrio-ovarian junction, step immediately followed in this developmental phase by completion oophorectomy. Four methods of partial ovarian transsection were prospectively compared: sharp division, stapler, bipolar division and harmonic scalpel. Surgical safety and pathological alterations were assessed. All specimens underwent extensive pathological evaluation using both SEE-FIM protocol and serial sections.
  
  
  RESULTS
  Fourteen women were enrolled in the study. Sharp and EndoGIA® appeared to be the safest methods of ovarian resection providing the best specimen quality for pathological examination.
  
  
  CONCLUSIONS
  We believe this technique could be suggested to young mutation carriers reluctant to undergo BSO. This approach is preferable to no prophylactic surgery at all. However, until the safety and validity of this procedure is confirmed by a multi-institutional study, women who undergo radical fimbriectomy should continue to receive regular multimodal evaluation and be advised of the risks involved until they finally accept secondary castration.
authors.affiliation: Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France. e-leblanc@o-lambret.fr
authors.forename: Eric
authors.initials: E
authors.lastname: Leblanc
authors.forename: Fabrice
authors.initials: F
authors.lastname: Narducci
authors.forename: Isabelle
authors.initials: I
authors.lastname: Farre
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Peyrat
authors.forename: Sophie
authors.initials: S
authors.lastname: Taieb
authors.forename: Claude
authors.initials: C
authors.lastname: Adenis
authors.forename: Philippe
authors.initials: P
authors.lastname: Vennin
mesh_terms: D005187:Fallopian Tubes / Q000601:surgery*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D018095:Germ-Line Mutation; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D010051:Ovarian Neoplasms / Q000235:genetics* / Q000517:prevention & control* / Q000601:surgery; D010053:Ovary / Q000601:surgery*; D012489:Salpingostomy / Q000379:methods