Peritoneal carcinomatosis after risk-reducing surgery in BRCA1/2 mutation carriers

Cancer. 2018 Mar 1;124(5):952-959. doi: 10.1002/cncr.31211. Epub 2018 Jan 9.


Background: Risk-reducing salpingo-oophorectomy (RRSO) is recommended for BRCA1/2 mutation carriers because of their increased risk of ovarian carcinoma. Despite RRSO, metachronous peritoneal carcinomatosis occasionally is diagnosed.

Methods: The literature was searched for BRCA1/2 mutation carriers with peritoneal carcinomatosis after risk-reducing surgery. The authors were asked for additional data. Clinical and histopathological data were descriptively analyzed. Cases were compared with a single-institution control cohort.

Results: Of 36 cases, 86.1% concerned BRCA1 mutation carriers. The median age of the patients was 52 years (range, 30-71 years) at the time of risk-reducing surgery and 60 years (range, 37-75 years) at the time of diagnosis of peritoneal carcinomatosis. The median interval between the 2 events was 54.5 months (range, 11-292 months). Peritoneal carcinomatosis was mostly high-grade serous carcinoma. Histopathological details of the RRSO specimens were retrieved in 8 cases; 5 (62.5%) were found to have serous tubal intraepithelial carcinoma and 1 had epithelial atypia. Cases were older (P = .025) at the time of risk-reducing surgery and harbored more serous tubal intraepithelial carcinomas (P<.001) compared with women from the control cohort.

Conclusions: Metachronous peritoneal carcinomatosis after risk-reducing surgery occurs predominantly in BRCA1 mutation carriers, usually within 5 years. Data have suggested that surgery at a younger age lowers the rates of peritoneal carcinomatosis. These data can be used in the gynecologic counseling of BRCA1/2 mutation carriers. RRSO should include complete salpingectomy. Detailed histopathological examination of specimens removed during RRSO is essential. Cancer 2018;124:952-9. © 2018 American Cancer Society.

Keywords: BRCA1 genes; BRCA2 genes; cystadenocarcinoma; ovariectomy; peritoneal neoplasms; prophylactic surgical procedures; salpingectomy; serous.

MeSH terms

  • Adult
  • Aged
  • BRCA1 Protein / genetics*
  • BRCA2 Protein / genetics*
  • Female
  • Heterozygote
  • Humans
  • Middle Aged
  • Mutation*
  • Peritoneal Neoplasms / diagnosis*
  • Peritoneal Neoplasms / etiology
  • Risk Factors
  • Salpingo-oophorectomy / adverse effects
  • Salpingo-oophorectomy / methods*


  • BRCA1 Protein
  • BRCA2 Protein