Grand Rounds

Are There any Minor Risks Involved with the ‘Opportunistic’ Removal of Fallopian Tubes to Prevent Cancer During Hysterectomy or Sterilization Procedures

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

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)

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

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”

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