Oncologic impact of prophylactic oophorectomy in colorectal cancer surgery: A systematic review and meta-analysis.

Abstract

e15536 Background: The evidence supporting routine prophylactic oophorectomy (PO) during colorectal cancer surgery remains limited and heterogeneous, and there is no consensus regarding routine PO for colorectal patients. We performed a systematic review and meta-analysis to evaluate whether PO provides oncological benefit in patients undergoing surgery for colorectal cancer. Methods: We searched PubMed, Embase, and Cochrane Library for studies comparing PO with ovarian preservation during colorectal cancer surgery. Overall (OS) and disease-free survival (DFS) were analyzed using hazard ratios (HRs), while categorical and continuous outcomes were assessed using risk ratios (RRs) and mean differences (MDs), respectively. Primary outcomes were OS and DFS. Secondary outcomes included perioperative and oncologic endpoints. We considered a 95% confidence interval (CI), and a p-value < 0.05 was statistically significant using Review Manager (RevMan) version 5.4.1. Results: Seven studies (four randomized controlled trials and three cohort studies) including 1,270 patients undergoing oncologic colorectal resection were analyzed. Overall, 445 patients (35.0%) underwent prophylactic oophorectomy; the mean age was 62.5 ± 9.4 years, and 92.1% of patients in the prophylactic oophorectomy group were postmenopausal. On pooled analysis, prophylactic oophorectomy was not associated with improvements in OS (HR 1.17; 95% CI, 0.78–1.75; p = 0.45; I² = 61%) or DFS (HR 1.29; 95% CI, 0.98–1.69; p = 0.07; I² = 11%), nor with differences in local recurrence (RR 1.32; 95% CI, 0.74–2.36; p = 0.35; I² = 77%), postoperative complications (RR 0.90; 95% CI, 0.65–1.26; p = 0.55; I² = 60%), or operative time (MD 6.57 minutes; 95% CI, −22.77 to 35.91; p = 0.66; I² = 93%). In a leave-one-out sensitivity analysis excluding the study incorporating cytoreductive surgery (CRS), prophylactic oophorectomy was associated with fewer postoperative complications (RR 0.82; 95% CI, 0.68–0.98; p = 0.03; I² = 8%). Conclusions: In this systematic review and meta-analysis, PO during colorectal cancer surgery was not associated with improvements in OS or DFS, nor with reductions in local recurrence or operative time compared with ovarian preservation. Overall complication rates were similar between groups; however, sensitivity analysis excluding the CRS study suggested a lower complication rate with PO. Taken together, these findings do not support routine as standard practice, indicating that PO should only be reserved for selected cases.