What is the history of a total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO)?

From the Guidelines

A history of total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) is a significant surgical procedure that can have a substantial impact on a patient's quality of life and risk of developing certain types of cancer. Given the patient's history of TAH-BSO, it is essential to consider the potential risks and benefits of this procedure in the context of their overall health and medical history. The patient's risk of developing endometrial and ovarian cancer is significantly reduced due to the removal of the uterus, fallopian tubes, and ovaries 1. However, it is crucial to note that the patient may still be at risk for other types of cancer, such as colorectal, gastric, and small bowel cancer, and should undergo regular surveillance and screening as recommended by the National Comprehensive Cancer Network (NCCN) guidelines 1. Some key points to consider in the patient's care include:

• The patient's risk of endometrial cancer is reduced, but they should still be educated on the importance of prompt reporting and evaluation of any abnormal uterine bleeding or postmenopausal bleeding 1.
• The patient's risk of ovarian cancer is also reduced, but they should still undergo regular surveillance and screening as recommended by the NCCN guidelines 1.
• The patient should be considered for estrogen replacement therapy to mitigate the risks of premature menopause due to oophorectomy 1.
• The patient should undergo regular upper GI surveillance with high-quality EGD starting at age 30-40 years and repeat every 2-4 years, preferably performed in conjunction with colonoscopy 1. In summary, a patient with a history of TAH-BSO requires careful consideration of their individual risks and benefits, as well as regular surveillance and screening to mitigate their risk of developing certain types of cancer.

From the Research

History of Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy

• The history of total abdominal hysterectomy with bilateral salpingo-oophorectomy dates back to several decades, with various studies examining its outcomes and effects on patients' quality of life 2, 3, 4, 5, 6.
• A study published in 1999 compared the feasibility of abdominal, laparoscopic, and vaginal hysterectomy with bilateral salpingo-oophorectomy, finding that the vaginal route resulted in shorter operating time, hospital stay, and recovery time compared to other methods 4.
• Another study published in 2011 compared total laparoscopic hysterectomy with total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometrial carcinoma, finding that laparoscopic hysterectomy resulted in better postoperative quality of life and recovery in the first 12 weeks after surgery 5.
• A systematic review and meta-analysis published in 2024 examined the long-term outcomes of hysterectomy with bilateral salpingo-oophorectomy, finding associations with decreased risk of breast cancer, but increased risks of colorectal cancer, cardiovascular diseases, and other conditions 6.
• A retrospective review published in 2013 examined patient-reported outcomes after total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometriosis, finding significant improvements in health-related quality of life, particularly in core domains such as control and powerlessness, emotional wellbeing, and social support 2.
• A population-based study published in 2021 examined practice variation in bilateral salpingo-oophorectomy at benign abdominal hysterectomy, finding marked between-surgeon variation in bilateral salpingo-oophorectomy rates, even after adjusting for patient case mix 3.

Surgical Approaches and Outcomes

• Different surgical approaches, including abdominal, laparoscopic, and vaginal hysterectomy with bilateral salpingo-oophorectomy, have been compared in terms of outcomes and feasibility 4, 5.
• The choice of surgical approach may depend on various factors, including patient characteristics, surgeon preference, and hospital resources 3, 4.
• Studies have reported varying outcomes, including improvements in quality of life, reduced symptoms, and increased risks of certain conditions, such as cardiovascular diseases and dementia 2, 5, 6.

Patient-Reported Outcomes and Quality of Life

• Patient-reported outcomes, including health-related quality of life, have been examined in several studies, with findings indicating significant improvements after total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometriosis 2.
• The Endometriosis Health Profile-30 (EHP-30) questionnaire has been used to assess patient-reported outcomes, including core domains such as control and powerlessness, emotional wellbeing, and social support 2.
• Quality of life and recovery have also been examined in studies comparing different surgical approaches, with findings indicating better postoperative quality of life and recovery after laparoscopic hysterectomy compared to abdominal hysterectomy 5.