Introduction Risk-reducing surgery (RRS) in Lynch Syndrome effectively prevents endometrial and ovarian cancers. Guidelines recommend discussing prophylactic hysterectomy and bilateral salpingo-oophorectomy (BSO) by age 40–45 for women with MLH1 or MSH2 mutations but lack consensus for timing of surgery. This study aims to define factors that impact decision-making for RRS.

Methods This IRB-approved retrospective study assessed 282 women with Lynch Syndrome with records from 2002–2020. Those preoperatively diagnosed with endometrial hyperplasia or cancer were excluded (n=75). The cohort was divided by mutation and age. Medical history was collected. Comparisons were made with Chi-Squared, McNemar, and Fisher exact tests. Compliance was calculated as the proportion of patients who underwent RRS by the specified age compared to all who met that age.

Results For MLH1 and MSH2 mutation carriers, compliance increased from 47.6% by age 45 to 68.4% by age 50 (p=0.001). Ten patients with prior bowel surgery or pelvic radiation underwent RRS by age 50 compared to 42 patients without this history (p=0.001). Compliance was 41.7% and 80.8% respectively. Surgery by age 50 included: 46 (88.5%) hysterectomy with BSO, 5 (9.6%) hysterectomy alone, and 1 (1.9%) BSO alone. The patient who underwent BSO alone had prior bowel surgery and radiation.

Conclusion The decision to undergo RRS in women with Lynch Syndrome is complex and often individualized. Factors that impact the compliance and timing of surgery include age, mutation status, and prior bowel surgery or pelvic radiation.