Opportunistic Salpingectomy: A Surgical Approach to Reducing Ovarian Cancer Risk

SUMMARY:

ACOG addresses the role of opportunistic salpingectomy in reducing ovarian cancer risk for women undergoing hysterectomy (benign conditions) or cesarean section.  The recommendations apply to women at average ‘population’ risk for ovarian cancer and not those at high risk (for example BRCA mutation carriers). Risks and benefits should be discussed with women considering opportunistic salpingectomy.

Science Behind the Guidance

• “Strong” data suggests that ovarian cancers (including serous, endometrioid, and clear cell) derive from endometrium or fallopian tube and not ovary itself
• Therefore, bilateral salpingectomy at time of hysterectomy or cesarean, even if ovaries are left in situ, should reduce ovarian cancer risk
• Note: Even if the above is correct, some ovarian cancers will arise from the ovary, not the tube | Opportunistic salpingectomy should not be considered 100% preventative

Risks Associated with Opportunistic Salpingectomy

• The following complications have not been demonstrated in women undergoing opportunistic salpingectomy
  • Infection | transfusion | readmission | postop complications
  • Ovarian function does not appear to be impaired
  • See ‘Related ObG Topics’ below for research summaries
• ACOG states that “salpingectomy at the time of hysterectomy or as a means of tubal sterilization appears to be safe”

Benefits Compared to Bilateral Salpingo-Oophorectomy (BSO)

• Literature supports the option of opportunistic salpingectomy for ovarian cancer risk reduction in the setting of benign surgery
• BSO and resultant surgical menopause elevates risk for the following
  • Cardiovascular disease
  • Osteoporosis
  • Cognitive impairment
  • All cause-mortality
  • Cancers (lung, colon, bladder and ‘any cancer’ – see BMJ study below in ‘Learn More – Primary Sources’)
• There is “little benefit” to ovarian conservation >65 years of age

KEY POINTS:

Technique

• Ideally, tube should be removed from fimbriated end to uterotubal junction
  • If not possible, remove as much as safely feasible
• Remove or cauterize fimbrial tissue if adherent to the ovary
• Choice of opportunistic salpingectomy should not impact route of hysterectomy

Learn More – Primary Sources:

BMJ (2017): Removal of all ovarian tissue versus conserving ovarian tissue at time of hysterectomy in premenopausal patients with benign disease: study using routine data and data linkage

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

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