Castrating operations associated with metastatic lesions of the breast.

To determine whether subsequent pelvic difficulty justified hysterectomy in cases of surgical castration performed as treatment of breast cancer, 432 cases so operated on at the Mayo Clinic for the 13 years 1955-1967 were reviewed. Oophorectomy alone was done in 353 patients, oophorectomy plus hysterectomy in 79. The age range in the oophorectomy group was 18-59 years, in the hysterectomy group 28-63 years. In each, 55% of the patients were less than 50-years-old. Of 367 patients in whom the procedure was therapeutic, 88 were found to have metastatic carcinoma in 1 or both ovaries. Inspection at the operating table had failed to reveal these metastases. Of the 79 uteri removed, 74 had demonstrable pathologic process. In 7 cases lesions were malignant. Postoperative vaginal bleeding occurred later in 14 of the 353 cases in which the uterus had been left in place. Morbidity rates, as determined by fever on 2 postoperative days, were 44% in the hysterectomy group, 26% in the oophorectomy group. Cause of the fever was not determined in half of these cases. Each group included a single case of afebrile thrombophlebitis. Hospital stay averaged 8 days for oophorectomy, 10 days for hysterectomy patients. Castration of the premenopausal patient with metastatic breast cancer offers a chance of remission. About a third of such patients are benefitted and survival may be increased 2 years. Surgical castration is preferred over irradiation because it gives more rapid hormone withdrawal. All ovarian tissue must be removed, especially when adhesions or endometriosis is present. Hysterectomy at the time of oophorectomy is considered justified except in poor-risk patients.