Extirpar los ovarios durante una histerectomía no proporciona beneficios

Es muy frecuente la realización de histerectomía (extirpación del útero) que en muchos casos se acompaña de la extirpación de los ovarios sanos, sin patología, para supuestamente prevenir un cáncer de ovario. También está muy extendida la creencia popular de que puesto que hay que operar, “mejor quitar todo, vaciar”. Durante mucho tiempo ha habido una fuerte controversia en la materia.

Cuando se someten a histerectomía por una enfermedad benigna, a muchas mujeres se les ofrece la posibilidad de extirpar los ovarios de forma preventiva o profiláctica con el fin de prevenir el cáncer de ovario o la aparición de lesiones benignas en esos órganos. Solo en Estados Unidos, se realizan 300.000 procedimientos anuales. En una nueva revisión sobre la materia se indica que la evidencia disponible es de baja calidad; pero que en la mayoría de casos no está justificada la ovariectomía profiláctica.

El Dr. Leonardo J. Orozco, del Hospital San Jose, in Costa Rica, ha realizado una revisión Cochrane sobre la materia que se limita a tan solo un ensayo clínico de 362 mujeres de 45 a 55 que se sometieron a histerectomía, de las cuales 106 decidieron también someterse a ovariectomía. Los datos dejan muchas preguntas sin contestar.

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Orozco LJ, Salazar A, Clarke J, Tristan M. Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women. Cochrane Database Syst Rev 2008 Jul 16;(3):CD005638.

OBGYN Women's Hospital San José, Costa Rica., Caja Costarricense Seguro Social (CCSS)., Bo california, San José, San Pedro Montes de Oca, Costa Rica, 1677-2100.

BACKGROUND: Prophylactic oophorectomy alongside hysterectomy in premenopausal women is common. The decision to remove or conserve the ovaries is often based on the perceived risk for ovarian cancer and the need for other additional gynaecological surgical interventions. The benefits or harms of prophylactic bilateral oophorectomy at the time of hysterectomy in premenopausal women are unknown. OBJECTIVES: To determine whether premenopausal women with hysterectomy without oophorectomy for benign gynaecological conditions versus hysterectomy plus bilateral oophorectomy would have a higher mortality rate and future gynaecological surgical interventions. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (December 2005 to October 2007) and the following electronic databases: CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE (January 1966 to October 2007), EMBASE (January 1985 to October 2007), LILACS (January 1982 to October 2007), Biological Abstracts (January 1968 to October 2007), NHS Economic Evaluation Database (inception to October 2007), Health Technology Assessment Database (inception to October 2007), and the Meta RCTs (inception to October 2007). Reference lists of relevant articles were also searched. SELECTION CRITERIA: Randomised controlled and controlled trials of hysterectomy (using any surgical approach) without oophorectomy versus hysterectomy (using any surgical approach) with bilateral oophorectomy in premenopausal women with benign gynaecological conditions. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trials for inclusion, determined study quality and extracted data. Study authors were contacted where information was unclear. MAIN RESULTS: Of the 119 studies identified, only one controlled trial was included. Therefore, a quantitative meta-analysis was not feasible. The results of this study (with two publications) including 362 women were summarised in a narrative format. No randomised controlled trials were found.Neither publication reported on the primary outcomes stated in this review. The trial showed evidence of very low quality of a positive effect on psychological well-being for both groups at one year follow up. No significant differences were found between the groups of women studied regarding any aspect of their sexuality. AUTHORS' CONCLUSIONS: The conclusions of this review are limited by the lack of data. More research of higher methodological quality is needed.

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