title: Improved quality of risk-reducing salpingo-oophorectomy in Australasian women at high risk of pelvic serous cancer.
abstract: The quality of risk-reducing salpingo-oophorectomy (RRSO) performed in Australasian women was previously reported to be suboptimal. Here we describe the quality of RRSO performed since 2008 in women enrolled in the same cohort and determine whether it has improved.
  
  
  
  Prospective cohort study of women at high risk of pelvic serous cancer (PSC) in kConFab. Eligible women had RRSO between 2008 and 2014 and their RRSO surgical and pathology reports were reviewed. "Adequate" surgery and pathology were defined as complete removal and paraffin embedding of all ovarian and extra-uterine fallopian tube tissue, respectively. Associations between clinical factors and "adequate" pathology were assessed using logistic regression. Data were compared with published cohort data on RRSO performed prior to 2008 using Chi square test.
  
  
  
  Of 164 contemporary RRSOs performed in 78 centres, 158/159 (99%) had "adequate" surgery and 108/164 (66%) had "adequate" pathology. Surgery performed by a gynaecologic oncologist rather than a general gynaecologist [OR 8.2, 95%CI (3.6-20.4), p < 0.001], surgery without concurrent hysterectomy [OR 2.5, 95%CI (1.1-6.0), p = 0.03], more recent year of surgery [OR 1.4, 95%CI (1.1-1.8), p = 0.02], and clinical notation that indicated high risk [OR 19.4, 95%CI (3.1-385), p = 0.008] were independently associated with "adequate" pathology. Both surgery and pathology were significantly more likely to be "adequate" (p < 0.001) in this contemporary sample.
  
  
  
  The quality of RRSOs has significantly improved since our last report. Surgery by a gynaecologic oncologist who informs the pathologist that the woman is at high risk for PSC is associated with optimal RRSO pathology.
authors.affiliation: Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
authors.forename: Y C
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Centre of Biostatistics and Clinical Trials (BaCT) Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Bressel
authors.affiliation: Department of Gynaecology and Oncology, Mercy Hospital for Women, Heidelberg, VIC, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Grant
authors.affiliation: Department of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Russell
authors.affiliation: Research Division, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Smith
authors.affiliation: Research Division, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Picken
authors.affiliation: Research Division, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Camm
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.
authors.forename: B E
authors.initials: BE
authors.lastname: Kiely
authors.affiliation: Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia.|Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.
authors.forename: R L
authors.initials: RL
authors.lastname: Milne
authors.affiliation: Department of Oncology, St Vincent's Hospital, Fitzroy, VIC, Australia.|Department of Medicine, St Vincent's Hospital, University of Melbourne, Parkville, VIC, Australia.
authors.forename: S A
authors.initials: SA
authors.lastname: McLachlan
authors.affiliation: Department of Obstetrics and Gynaecology, The University of Melbourne and the Royal Women's Hospital, Parkville, VIC, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Hickey
authors.affiliation: Department of Medical Oncology, The Prince of Wales Hospital, Randwick, NSW, Australia.
authors.forename: M L
authors.initials: ML
authors.lastname: Friedlander
authors.affiliation: Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.
authors.forename: J L
authors.initials: JL
authors.lastname: Hopper
authors.affiliation: Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. Kelly.phillips@petermac.org.|Department of Medicine, St Vincent's Hospital, University of Melbourne, Parkville, VIC, Australia. Kelly.phillips@petermac.org.|Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia. Kelly.phillips@petermac.org.|Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia. Kelly.phillips@petermac.org.
authors.forename: K A
authors.initials: KA
authors.lastname: Phillips
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D018284:Cystadenocarcinoma, Serous / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D005185:Fallopian Tube Neoplasms / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006579:Heterozygote; D006801:Humans; D008875:Middle Aged; D009520:New Zealand; D000072103:Oncologists; D010051:Ovarian Neoplasms / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D065286:Prophylactic Surgical Procedures; D011446:Prospective Studies; D011787:Quality of Health Care; D012307:Risk Factors; D000074868:Salpingo-oophorectomy / Q000379:methods*
keywords: BRCA1 mutation carrier; BRCA2 mutation carrier; Ovarian cancer prevention; Pelvic serous cancer; Risk-reducing salpingo-oophorectomy