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Grand Rounds

Should Fallopian Tubes Also Be Removed During Ovarian Conserving Benign Hysterectomy? 

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BACKGROUND AND PURPOSE:

  • Evidence exists that high-grade serous ovarian carcinoma may begin in the distal fallopian tube in the majority of cases
  • ACOG and SGO have recommended that bilateral salpingectomy be considered and discussed with patients at the time of ovarian conserving benign hysterectomy
  • Till et al. (JMIG, 2017) aimed to:
    • Determine if there has been change in practice regarding opportunistic salpingectomy
    • Examine patient, operative and hospital related factors
    • Evaluate complications that may be associated with salpingectomy

METHODS:

  • Retrospective cross-sectional study of women undergoing ovarian conserving benign hysterectomy
  • Primary outcomes were performance of opportunistic salpingectomy with ovarian preservation
  • Rate of salpingectomy was examined at four-month intervals to study changes over time
  • Independent effects of patient co-morbidities and operative/hospital factors were evaluated

RESULTS:

  • 21,978 women undergoing hysterectomy were obtained from the database
    • 10,676 ovarian conserving benign surgeries were analyzed
  • Salpingectomy rate was 45.8% (n= 4,890)
  • Rates of opportunistic salpingectomy increased over the study period from 27.5% to 61.6% (p<0.001)
  • Salpingectomy was more likely with laparoscopic approach, nulliparity and age <60
  • Salpingectomy rate was variable between hospitals
  • Although salpingectomy increased operative time by 12 minutes, there was no increase in estimated blood loss or perioperative complications

CONCLUSION:

  • Salpingectomy rate increased as the study progressed
  • Laparoscopic approach and younger ager are associated with increased probability of salpingectomy
  • Salpingectomy are not associated with perioperative complications or increased blood loss
  • Increasing the salpingectomy rate should be a quality improvement target, in keeping with ACOG guidance
  • Stuparich et al. (JMIG, 2017) have developed an educational video on how to perform salpingectomy during laparoscopic hysterectomy is publicly available (see ‘Learn More – Primary Sources’ below)

Learn More – Primary Sources:

Utilization of Opportunistic Salpingectomy at Time of Benign Hysterectomy

ACOG Committee Opinion 774: Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention

SGO Clinical Practice Statement: Salpingectomy for Ovarian Cancer Prevention

Tips and Tricks for Performing Salpingectomy at the Time of Laparoscopic Hysterectomy

Video on Tips and Tricks for Performing Salpingectomy at the Time of Laparoscopic Hysterectomy

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IUD, Hysterectomy or Ablation for Menorrhagia?
Uterine Artery Embolization, Focused Ultrasound, or Hysterectomy for Fibroids?
Obstetrics Critical Care Course
Screening for Ovarian Cancer – Fantasy or Reality?

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