title: Salpingo-oophorectomy at the Time of Benign Hysterectomy: A Systematic Review.
abstract: OBJECTIVE
  To compare the long-term risks associated with salpingo-oophorectomy with ovarian conservation at the time of benign hysterectomy.
  
  
  METHODS
  MEDLINE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials were searched from inception to January 30, 2015. We included prospective and retrospective comparative studies of women with benign hysterectomy who had either bilateral salpingo-oophorectomy (BSO) or conservation of one or both ovaries.
  
  
  METHODS
  Reviewers double-screened 5,568 citations and extracted eligible studies into customized forms. Twenty-six comparative studies met inclusion criteria. Studies were assessed for results, quality, and strength of evidence.
  
  
  RESULTS
  Studies were extracted for participant, intervention, comparator, and outcomes data. When compared with hysterectomy with BSO, prevalence of reoperation and ovarian cancer was higher in women with ovarian conservation (ovarian cancer risk of 0.14-0.7% compared with 0.02-0.04% among those with BSO). Hysterectomy with BSO was associated with a lower incidence of breast and total cancer, but no difference in the incidence of cancer mortality was found when compared with ovarian conservation. All-cause mortality was higher in women younger than age 45 years at the time of BSO who were not treated with estrogen replacement therapy (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.04-1.92). Coronary heart disease (HR 1.26, 95% CI 1.04-1.54) and cardiovascular death were higher among women with BSO (HR 1.84, 95% CI 1.27-2.68), especially women younger than 45 years who were not treated with estrogen. Finally, there was an increase in the prevalence of dementia and Parkinson disease among women with BSO compared with conservation, especially in women younger than age 50 years. Clinical practice guidelines were devised based on these results.
  
  
  CONCLUSIONS
  Bilateral salpingo-oophorectomy offers the advantage of effectively eliminating the risk of ovarian cancer and reoperation but can be detrimental to other aspects of health, especially among women younger than age 45 years.
authors: University of Texas Health Science Center San Antonio, San Antonio, Texas; Women & Infants Hospital, Alpert Medical School of Brown University, and the Center for Evidence Based Medicine, Brown University, Providence, Rhode Island; Baylor College of Medicine, Houston, Texas; the University of California, San Diego, San Diego, California; Case Western Reserve University School of Medicine, Cleveland, Ohio; Carilion Clinic, Roanoke, Virginia; Columbia University, College of Physicians and Surgeons, New York, New York; the University of New Mexico, Albuquerque, New Mexico; the University of South Carolina School of Medicine, Greenville, South Carolina; and the Institute for Female Pelvic Medicine and Reconstructive Surgery, North Wales, Pennsylvania.
authors: Elizabeth Casiano
authors: EC
authors: Evans
authors: Kristen A
authors: KA
authors: Matteson
authors: Francisco J
authors: FJ
authors: Orejuela
authors: Marianna
authors: M
authors: Alperin
authors: Ethan M
authors: EM
authors: Balk
authors: Sherif
authors: S
authors: El-Nashar
authors: Jonathan L
authors: JL
authors: Gleason
authors: Cara
authors: C
authors: Grimes
authors: Peter
authors: P
authors: Jeppson
authors: Cara
authors: C
authors: Mathews
authors: Thomas L
authors: TL
authors: Wheeler
authors: Miles
authors: M
authors: Murphy
mesh_terms: D000367:Age Factors; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D059351:Organ Sparing Treatments / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D010051:Ovarian Neoplasms / Q000517:prevention & control*; D010052:Ovariectomy / Q000379:methods*; D018579:Patient Selection; D018570:Risk Assessment; D058994:Salpingectomy / Q000379:methods*