Long-term outcomes of hysterectomy with bilateral salpingo-oophorectomy: a systematic review and meta-analysis
Hend Hassan, Isaac Allen, Eleni Sofianopoulou, Yvonne Walburga, Clare Turnbull, Diana M. Eccles, Marc Tischkowitz, Paul D.P. Pharoah, Antonis C. Antoniou
Abstract
Objective To provide an up-to-date systematic review on “the long-term outcomes of bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy” and perform a meta-analysis for the reported associations. Data sources We 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 We included studies of women who had hysterectomy with BSO compared to hysterectomy with ovarian conservation or no surgery. Study appraisal and Synthesis methods Quality of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Adjusted hazard ratios were extracted and combined to obtain fixed effect estimates. Results Hysterectomy with BSO in young women compared to hysterectomy or no surgery was associated with decreased risk of breast cancer (HR:0.78, 95% CI: 0.73-0.84), but with increased risk of colorectal cancer (HR:1.27, 95%CI:1.10-1.47). Additionally, it was associated with increased risk of total cardiovascular diseases, coronary heart disease and stroke with hazard ratios 1.18 (95%CI: 1.11-1.25), 1.17 (95%CI: 1.10-1.25), 1.20(95% CI: 1.10-1.31), respectively. Compared to no surgery hysterectomy with BSO before the age of 50 was associated with increased risk of hyperlipidaemia (HR:1.44, 95% CI:1.25-1.65), diabetes (HR:1.16, 95%CI:1.09-1.24), hypertension (HR:1.13, 95%CI:1.06-1.20), dementia (HR:1.70, 95%CI:1.07-2.69) and depression (HR:1.39, 95%CI:1.22-1.60). Evidence on the association with all-cause mortality in young women showed substantial heterogeneity between the studies (I2:85%, p-value: <0.01). Conclusion Hysterectomy with BSO is associated with multiple long-term outcomes. The benefits of the addition of BSO to hysterectomy should be balanced against the risks. To provide an up-to-date systematic review on “the long-term outcomes of bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy” and perform a meta-analysis for the reported associations. We updated a previous systematic review by searching the literature using PubMed, Web of science and Embase for publications between January 2015 and August 2022. We included studies of women who had hysterectomy with BSO compared to hysterectomy with ovarian conservation or no surgery. Quality of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Adjusted hazard ratios were extracted and combined to obtain fixed effect estimates. Hysterectomy with BSO in young women compared to hysterectomy or no surgery was associated with decreased risk of breast cancer (HR:0.78, 95% CI: 0.73-0.84), but with increased risk of colorectal cancer (HR:1.27, 95%CI:1.10-1.47). Additionally, it was associated with increased risk of total cardiovascular diseases, coronary heart disease and stroke with hazard ratios 1.18 (95%CI: 1.11-1.25), 1.17 (95%CI: 1.10-1.25), 1.20(95% CI: 1.10-1.31), respectively. Compared to no surgery hysterectomy with BSO before the age of 50 was associated with increased risk of hyperlipidaemia (HR:1.44, 95% CI:1.25-1.65), diabetes (HR:1.16, 95%CI:1.09-1.24), hypertension (HR:1.13, 95%CI:1.06-1.20), dementia (HR:1.70, 95%CI:1.07-2.69) and depression (HR:1.39, 95%CI:1.22-1.60). Evidence on the association with all-cause mortality in young women showed substantial heterogeneity between the studies (I2:85%, p-value: <0.01). Hysterectomy with BSO is associated with multiple long-term outcomes. The benefits of the addition of BSO to hysterectomy should be balanced against the risks.