Introduction/Background Guidelines recommend bilateral salpingo-oophorectomy(BSO) at age 40 for BRCA1-women and 45 for other cases. However, severe adverse effects associated with BSO and induced premature menopause may be associated. Radical fimbriectomy(RF) followed by bilateral oophorectomy(BO) may represent an alternative for women refusing early BSO.

Methodology From 12/2014 to 12/2022 we retrospectively reviewed all consecutive high-risk women addressed for prophylactic surgery, non-menopausal status and childbearing completion refusing BSO. The primary endpoint was to estimate the cumulative incidence of ovarian and pelvic invasive cancer after RF. Secondary endpoints were the evaluation of the RF-related morbidity; the prevalence of incidental in situ or invasive lesions found on surgical specimens; the occurrence of menopause at the last follow-up and before DO. The cumulative incidence of ovarian/pelvic invasive cancer was estimated using the Kalbfleisch-Prentice method. Follow-up was estimated using the inverse Kaplan-Meier method.

Results 167 women were identified. Median age at RF was 39(range 28–48). Most of the population were BRCA1(65,3%) and BRCA2(25,2%) mutated women. In 126 cases(75,4%) any fallopian tubal lesion was detected. Among the other 41 wome(24,6%), 2 HGSC and 7 STIC lesions were diagnosed(5,5%). In 32 women(19,6%), the analysis revealed HGSOC precursor lesions(STIL, SCOUT, TILT) and/or p53 signatures. All procedures(100%) were performed by laparoscopy, with no major-related postoperative complications. With a median follow-up of 37 months (range 2–142) no ovarian or pelvic HSGOC have been reported among the 163 women analyzed(2 loss of follow-up, 2 HGSOC). DO was performed by laparoscopy in 32 women(19,4%) with median age at 45 years old(range 36–53). No abnormalities were found. 35 women were menopaused, 1(6,7%) after BO and 24(14,5%) spontaneously. Median age at menopause was 45 (range 37–53). Two patients were pregnant by assisted reproductive technology after RF.

Conclusion RF followed by DO seems a safe risk-reducing approach to avoid early menopause in high-risk population in our retrospective cohort.

Disclosures None.