BACKGROUND AND PURPOSE:

• High-grade serous ovarian cancer appears to actually begin in the fallopian tube
• Professional colleges (including ACOG and SOGC) are recommending ‘opportunistic salpingectomy’ for cancer prevention in average risk population
  • At time of hysterectomy (ovarian preservation)
  • As a mode of permanent sterilization
• Data is limited regarding whether there are minor, clinically significant complications associated with opportunistic salpingectomy
• Hanley et al. (AJOG, 2018) sought to address the risks of minor complications associated with opportunistic salpingectomy

METHODS:

• Population-based retrospective cohort study (2008-2014) in British Columbia
• Participants: Women had either
  • Opportunistic salpingectomy with hysterectomy
  • Hysterectomy alone
  • Hysterectomy with a bilateral salpingo-oophorectomy (BSO)
  • Opportunistic salpingectomy for sterilization
  • Tubal ligation (tubes left in situ)
• Excluded surgeries for gyn malignancies
• Adjusted odds ratio (aOR): Odds ratios adjusted for
  • Other gynecologic conditions | Surgical approach | Patient age
• Primary outcomes: The following occurrences within 2 weeks after discharge
  • Surgical infection | Surgical complication | Orders for lab tests and imaging | Frequency of filled prescription for an antibiotic or prescription strength analgesic (exluding over the counter pain relievers)

RESULTS:

• 49,275 women were included in the study
  • Hysterectomy alone: 8231
  • Hysterectomy with opportunistic salpingectomy: 8508
  • Hysterectomy with BSO: 7273
  • Tubal ligation: 19,424
  • Opportunistic salpingectomy for sterilization: 5839
• Women who underwent opportunistic salpingectomy had
  • No increased risk for physician visits for surgical infection, surgical complication, additional lab or imaging orders
  • No increased risk for additional antibiotic prescriptions
• Women who underwent opportunistic salpingectomy had a 20% increased odds of filling a prescription for an analgesic within 2 weeks postop
  • Hysterectomy with opportunistic salpingectomy: aOR 1.23; 95%CI, 1.15-1.32
  • Opportunistic salpingectomy for sterilization: aOR 1.21; 95%CI, 1.14-1.29
  • This finding was no longer present at 1 month

CONCLUSION:

• There is no risk for minor complications with the addition of opportunistic salpingectomy when compared to hysterectomy alone or tubal ligation
• There was a slight increase in risk for additional prescriptions for analgesics, however, the authors state that “this risk will likely be far outweighed by the potential long-term benefit”

Learn More – Primary Sources:

Extending the safety evidence for opportunistic salpingectomy in prevention of ovarian cancer: A cohort study from British Columbia, Canada

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