Pre-Operative Evaluation and Planning for Total Hysterectomy and Bilateral Salpingo-Oophorectomy

Essential Preoperative Assessments

• Family history evaluation is mandatory to identify genetic cancer syndromes that may influence surgical approach and extent, as recommended by the National Comprehensive Cancer Network 1, 2, 3
• Comorbidity inventory must be documented, including cardiovascular disease, diabetes, and bone health status, to impact decisions about oophorectomy timing and hormone replacement, according to the National Comprehensive Cancer Network 1, 2, 3
• Geriatric assessment should be performed when appropriate to evaluate surgical candidacy, as suggested by the European Society for Medical Oncology 4

Required Imaging Studies

• Transvaginal ultrasound is the standard initial imaging modality to evaluate uterine pathology and adnexal structures, as recommended by the European Society for Medical Oncology 4
• CA-125 and pelvic ultrasound are recommended for preoperative planning when oophorectomy is planned, according to the National Comprehensive Cancer Network 2, 3
• Contrast-enhanced MRI should be obtained to assess cervical involvement or myometrial invasion in apparent Stage I endometrial cancer, as suggested by the European Society for Medical Oncology 4

Surgical Planning Discussion

• Standard surgery includes total hysterectomy with bilateral salpingo-oophorectomy, which removes the uterus, cervix, both fallopian tubes, and both ovaries, as described by the British Journal of Cancer 5 and the National Comprehensive Cancer Network 6, 7
• Thorough abdominal exploration will include systematic inspection and palpation of the entire abdomen, liver, diaphragm, omentum, and peritoneal surfaces, as recommended by the British Journal of Cancer 5 and the National Comprehensive Cancer Network 6, 7

Critical Counseling Points

• Estrogen replacement therapy should be discussed for premenopausal women undergoing oophorectomy, as premature menopause causes detriments to bone health, cardiovascular health, and quality of life, according to the National Comprehensive Cancer Network 1, 2, 3
• Bilateral oophorectomy eliminates ovarian cancer risk, providing definitive prevention that cannot be achieved through screening alone, as recommended by the National Comprehensive Cancer Network 2, 3, 8

Common Pitfalls to Avoid

• Failure to obtain family history may miss hereditary cancer syndromes that significantly impact surgical decision-making and extent, as warned by the National Comprehensive Cancer Network 1, 2, 3
• Not discussing hormone replacement therapy preoperatively leaves premenopausal women unprepared for managing premature menopause symptoms, according to the National Comprehensive Cancer Network 1, 2, 3