Pioneering surgery giving patients an option to have two operations in one 

04/06/2018 00:00 
A woman who gave birth to her second child at UCLH recently had two surgeries in one, a caesarean section to deliver her baby and risk-reducing surgery to remove her fallopian tubes and ovaries because she is a carrier of the BRCA1 gene mutation.

The two-in-one surgery on UCLH patient and mum Emma Kyriacou, believed to be extremely rare, was covered by Channel 4 News' Health Editor Victoria Macdonald last Saturday.

The Channel 4 report, which billed it as "life giving and life saving surgery at the same time", ran: "For women with a family history of cancer – there’s a chance to get ahead of the disease by getting tested for the faulty BRCA gene. Many then decide to get their ovaries and fallopian tubes pre-emptively removed. Now doctors are encouraging women with the gene who are about to undergo any kind of abdominal or pelvic surgery, to consider getting their ovaries taken out at the same time. As our Health and Social Care correspondent Victoria MacDonalds reports, surgeons at University College London Hospital have done just that, in an operation they believe may be a world first."

The impending birth of Emma's second child in March led her to ask whether she could have risk-reducing surgery at the same time and her surgeon Adam Rosenthal along with the UCLH Familial Cancer Clinic MDT, and her obstetrician, Pat O’Brien, agreed it would be sensible. Adam also ran a search of the literature and could not find any reports of the two surgeries being done at the same time previously and felt this in itself was quite remarkable.

He explained: "We don't normally advocate having the risk reducing surgery before the age of 40 as it sets off early menopause, and the risk of cancer below that age is actually very small. But with mums having babies later, it can be appropriate to consider having surgery at the same time as a caesarean section, or indeed any other surgery inside the abdomen or pelvis."

Emma said: "I had breast cancer almost five years ago and gave birth to my first child three years ago. I knew I'd have to have the surgery because I'm still at risk of ovarian cancer so I thought I'd ask if I could have it at the same time as the birth of my second child. It was such a simple decision for me, it made sense to ask. I can't believe it's not been done before and I may have made medical history."

Adam added: "The case illustrates beautifully how more young women are learning of their risk of cancer through the wider availability of gene testing and can take preventive measures – in this case, the patient herself very sensibly asked if it could be done when she was having her caesarean."

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