laparascopic oophorectomy vs open surgery

[LeahSiegel]

I have stage 4 lobular carcinoma that is ER positive. My doctors agree I should have my ovaries taken out but they have different opinions about how to do it. One feels I should have it done laparscopically, as the recovery period is much shorter. The other feels I should have a traditional open surgery with a 4-8 week recovery period because there is a slight risk with laparoscopic surgery that they may miss some ovarian tissue. Additionally, they can remove the uterus which is just one more place for cancer to spread to... Is one surgical proceedure better than the other in terms of shutting down estrogen production?

[Cleveland Clinic]

Dear LeahSiegel:  In cancer that is Estrogen Receptor positive, there are several ways to block the estrogen.  In premenopausal women, tamoxifen is a commonly used drug.  In postmenopausal women, aromatase inhibitors are generally preferred.  A premenopausal women could be rendered postmenopausal in two ways:  1.  Drugs that will stop ovarian function and 2.  Removal of ovaries.  There are pros and cons of either choice and often this boils down to personal preference.  You may benefit from a discussion with your oncologist and even consider a second opinion if you are concerned.

[katarina777]

PPS: It is also possible that your surgeon is more experienced doing major surgery than he is with doing laporascopic procedures.

[katarina777]

PS: I had a follow up appointment with my oncologist just last week. He was sort of thinking out loud, and saying this to me: "I think you should have your ovaries removed, because that is the only way to be sure you are in menopause." (my periods stopped after my first chemotherapy, and I had stage 3C) I asked him how, and he said a little cut would be made...I figure he was talking laporascopic, as well. Because he did not tell me why he thought this was a good idea, I guessed and happened to have the right idea. I am on Tamoxifen now, and since there is some reason to believe that the 'Aromatose Inhibitors' work slightly better, but for those you should be post-menopausal, he felt we needed to make sure, and achieve so by removing the ovaries.

But he did not push the idea, and we decided that I was doing just fine on the Tamoxifen for now and that I could be switched in a year, or so.

The reason I am telling you this is, because just because your doctors agree you should have your ovaries removed, it doesn't mean this is the perfect thing to do. i think they probably feel because of your very advanced cancer, doing everything possible is to your advantage. You, on the other hand also have to think about the quality of your life from your point of view, and remember that they are 'doctors' first.

[katarina777]

In terms of shutting down estrogen production, you only need to have your ovaries removes. The laparoscopic surgery would be very appropriate for doing just that.

You need to understand, that what a doctor tells you, or advises will depend more than anything on his specialty.

So, if you have back pain, and you see a neurologist, the cause will be neurological. An orthopedist will tell you the problem is in your bones or soft tissue. A Physical therapist will work with your muscles, etc. A psychiatrist will believe it's psychological, i.e. depression related.

A surgeon will be much more likely to advise you that you should have a complete hysterectomy along with your ovaries removed than an oncologist. The oncologist cares about stopping estrogen production, and the surgery will first care about how much he can cut away, but not without cause, or reason, of course. In your case, he/she will argue, that you are at risk for metastasis, that you have no need for your uterus, and that he may as well prevent the possibility that the cancer will spread to your uterus, or otherwise the hormonal treatment cause adverse effects with the treatment. I personally don't think that the issue is that some tissue may be left behind.

There is no correct answer, really. it also makes a difference how good your insurance is, as most surgeons would not recommend extensive surgery if they don't get paid enough.

You are in a very vulnerable position. I think what I would do if I were you is, I would talk to your PCP. (if you trust him/her)  It may also help to speak to other people, or a woman, or get another opinion. (preferably someone who is not a specialist)

I am only telling you what I think and feel. My qualifications do  not come from being being an MD, but for for that very reason I think they may be worth hearing. I wish you the best.