Opportunistic salpingectomy for ovarian, fallopian tube, and peritoneal carcinoma risk reduction

Authors:: Jessica N McAlpine, MD, FACOG, FRCPSC; Gillian E Hanley, PhD
Section Editors:: Barbara Goff, MD; Howard T Sharp, MD
Deputy Editor:: Alana Chakrabarti, MD

Literature review current through: Jan 2024.

This topic last updated: Sep 06, 2023.

INTRODUCTION — Opportunistic salpingectomy (OS) is the removal of the fallopian tubes for primary prevention of epithelial ovarian, fallopian tube, and peritoneal carcinoma in a patient at average risk for these cancers and undergoing pelvic surgery for another indication. By contrast, risk-reducing bilateral salpingo-oophorectomy (rrBSO) is a procedure performed in patients at high risk for these cancers.

The preventive strategy of OS is based on an abundance of data demonstrating that the fallopian tubes, rather than the ovaries, are the primary site of most epithelial ovarian, fallopian tube, and peritoneal carcinomas. Salpingo-oophorectomy, rather than salpingectomy alone, is not considered part of primary prevention in premenopausal patients, as oophorectomy results in loss of ovarian function and is associated with long-term health risks.

OS for epithelial ovarian, fallopian tube, and peritoneal carcinoma risk reduction in average-risk patients is reviewed here. Risk-reducing salpingo-oophorectomy for patients at high risk for these cancers is discussed separately. (See "Risk-reducing salpingo-oophorectomy in patients at high risk of epithelial ovarian and fallopian tube cancer".)

OVERVIEW AND RATIONALE — Epithelial ovarian carcinoma (EOC) is not a single disease but rather consists of five different histotypes; in order of frequency, they include high-grade serous, endometrioid, clear cell, low-grade serous, and mucinous carcinomas. Because of their common features, high-grade serous ovarian, fallopian tube, and peritoneal carcinoma are considered one clinical entity and referred to as a single entity (EOC). (See "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Histopathology".)

In 2010, the British Columbia Ovarian Cancer Research (OVCARE) team proposed prophylactic salpingectomy as a strategy for primary prevention of EOC [1]; this was based on the following observations:

Role of the fallopian tube in carcinogenesis — The majority of EOCs arise from the epithelium of the distal fallopian tube rather than the ovary itself [2-4]. These findings may account for the observed residual risk of peritoneal high-grade serous carcinoma following oophorectomy without removal of the fallopian tubes [5-7]. (See "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Histopathology".)

In addition, in patients at high risk for EOC (eg, patients with BRCA1 and BRCA2 mutations) undergoing risk-reducing bilateral salpingo-oophorectomy (rrBSO), occult fallopian tube carcinomas and/or preinvasive lesions in the distal fallopian tubes (serous tubal intraepithelial carcinoma [STIC]) has been described; however, intensive examination of the ovaries in these patients have failed to find premalignant or malignant epithelial changes [8-15]. (See "Risk-reducing salpingo-oophorectomy in patients at high risk of epithelial ovarian and fallopian tube cancer", section on 'Counseling and consent'.)

Preinvasive lesions have also been found in fallopian tube specimens of average-risk patients who have not yet developed cancer, although this is rare [16-19]. These tubal specimens are typically from patients who underwent sterilization or hysterectomy for benign indications. Many or most of these patients are younger than 65 years, which is the average age of diagnosis of ovarian cancer in the general population. Thus, the low incidence of STICs in this population is not surprising.

An important component of the studies of rrBSO specimens has been the use of the Sectioning and Extensively Examining the Fimbria (SEE-FIM) protocol, which is a technique for sectioning and examination of the fallopian tube to maximize the detection of neoplasia [8,20]. Using this protocol, tubal involvement has been found in up to 75 percent of patients diagnosed with ovarian or primary peritoneal high-grade serous carcinoma (with and without BRCA mutations) [21-23], including the presence of fimbrial STICs in 40 to 60 percent [23-27].

Efficacy of tubal ligation in cancer reduction — Tubal ligation has consistently been shown to decrease the risk of developing EOC [28-41], with large retrospective studies reporting a greater risk reduction for nonserous cancers, particularly endometrioid and clear cell histotypes [34-36], than for serous cancers [35].

Possible mechanisms for risk reduction include the following: removing the initial site of carcinogenesis (high-grade serous carcinomas) [42]; removing the conduit for passage of endometriotic or endosalpingiotic cells (clear cell and endometrioid carcinomas) [43-45]; and removing the conduit for passage of carcinogens (eg, talc) or inflammation (eg, pelvic infection) to reach the ovary. However, the role of these factors is not well established. (See "Endosalpingiosis" and "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Incidence and risk factors", section on 'Talc'.)

Tubal ligation techniques include surgical clips or rings, cauterization, or partial salpingectomy. While most studies of tubal ligation and EOC do not report results for specific methods of tubal ligation, hysteroscopic tubal ligation methods are generally not included in these studies. (See "Overview of female permanent contraception".)

The role of complete salpingectomy in cancer reduction is discussed in detail below. (See 'Ovarian cancer risk reduction' below.)

Other

●Limitations in early detection and poor prognosis – In general, EOC presents at an advanced stage and has a poor prognosis (table 1 and table 2). The overall survival rate for patients with ovarian cancer has remained largely unchanged since the mid-1980s [46-50]. While clinical trials show that use of a poly (ADP-ribose) polymerase (PARP) inhibitor as maintenance therapy affords a progression-free survival advantage in select patients [51-54], whether it affords an overall survival advantage has not been reported, as data are immature. (See "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Incidence and risk factors", section on 'Incidence' and "Overview of epithelial carcinoma of the ovary, fallopian tube, and peritoneum", section on 'Prognosis' and "First-line chemotherapy for advanced (stage III or IV) epithelial ovarian, fallopian tube, and peritoneal cancer", section on 'PARP inhibitors'.)

●Limitations in screening – Various screening tools for ovarian cancer have not been shown to improve cancer-specific mortality. In the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) trial including over 202,000 postmenopausal patients followed for a median of 16 years, those undergoing annual screening (ie, multimodal, transvaginal ultrasound) versus no screening had similar rates of death from ovarian or tubal carcinomas [55]. This is discussed in more detail separately. (See "Screening for ovarian cancer", section on 'Lack of benefit of screening strategies'.)

For patients who present with signs or symptoms suggestive of ovarian cancer, evaluation may include serum biomarkers and pelvic imaging, but the specificity of these tests is low and many patients with benign adnexal masses undergo unnecessary surgeries [56-60]. (See "Approach to the patient with an adnexal mass", section on 'Assessing the risk of malignancy'.)

CANDIDATES — Candidates for OS include patients undergoing a pelvic operation for another indication (eg, hysterectomy for benign disease, permanent sterilization) and who have no plans for future pregnancy. If there are no indications for oophorectomy, the ovaries are conserved as oophorectomy is associated with adverse outcomes (eg, premature surgical menopause), including all-cause mortality and cardiovascular disease. (See "Elective oophorectomy or ovarian conservation at the time of hysterectomy".)

By contrast, patients at high risk for cancers of the fallopian tube, ovary, and peritoneum (eg, BRCA gene mutation, Lynch syndrome) are not candidates for OS and rather should undergo a risk-reducing bilateral salpingo-oophorectomy (rrBSO). While early salpingectomy with delayed oophorectomy has also been described in such patients [61], subsequent ovarian carcinomas (prior to the delayed oophorectomy) have been reported [62]. Thus, this practice remains investigational and studies are ongoing. (See "Risk-reducing salpingo-oophorectomy in patients at high risk of epithelial ovarian and fallopian tube cancer" and "Cancer risks and management of BRCA1/2 carriers without cancer", section on 'Bilateral salpingo-oophorectomy'.)

COUNSELING — In our practice, we counsel patients at average risk of epithelial ovarian carcinoma (EOC) who are undergoing hysterectomy for benign indications or sterilization about the risks and benefits of OS and employ shared decision-making with the patient. This is consistent with the approach of expert groups including the Society of Gynecologic Oncologists of Canada, Society of Gynecologic Oncology, American College of Obstetricians and Gynecologists, Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and German Society of Gynaecology and Obstetrics (Deutschen Gesellschaft für Gynäkologie und Geburtshilfe) [63-67].

In place of tubal ligation — For patients undergoing surgical sterilization, we discuss all options for sterilization, including complete salpingectomy, and communicate that sterilization by salpingectomy is not reversible. We share the available data regarding minimal added surgical time and risk of morbidity. (See 'Outcomes' below.)

We offer OS for permanent sterilization via laparoscopy or laparotomy, including at the time of cesarean birth; the timing of the sterilization procedure affects how it is performed. Postpartum sterilization is performed at the time of cesarean birth or via a mini-laparotomy. Patients who undergo interval sterilization (ie, not during a postpartum period) may have either a laparoscopic or mini-laparotomy procedure. (See "Overview of female permanent contraception", section on 'Timing and surgical approach'.)

Sterilization with complete salpingectomy cannot be reversed. Counseling for all patients undergoing sterilization should emphasize that it is a permanent procedure and that there is no possibility of a tubal reanastomosis.

Patients undergoing hysterectomy for benign indications — For most patients who undergo hysterectomy with ovarian conservation, we perform salpingectomy. For patients undergoing vaginal hysterectomy, removal of the tubes is feasible with a transvaginal approach or can be performed with laparoscopic assistance. We do not change the surgical route to be able to perform OS unless this is the strong preference of the patient. (See "Hysterectomy (benign indications): Selection of surgical route", section on 'Prophylactic oophorectomy or salpingectomy'.)

Patients undergoing other abdominal surgery — While OS at the time of other abdominal procedures (eg, cholecystectomy) has been described, it is not routinely performed, likely due to lack of physician and patient awareness. However, when such patients are offered OS, acceptance rates are high. In a prospective study including patients undergoing elective laparoscopic cholecystectomy, the acceptance rate of concurrent OS was approximately 60 percent [68]. Of the 105 patients in which both procedures were planned, salpingectomy was successfully completed in 93 percent of patients; seven patients (6.7 percent) did not have the procedure performed due to poor visibility or pelvic adhesions. (See 'Perioperative outcomes' below.)

PROCEDURE

The goal of OS is the removal of at least the distal one-third (fimbria and infundibulum, portion of ampulla) of both fallopian tubes (figure 1) as this is the origin of the majority of cancers and preinvasive lesions in both the general population and BRCA1 and BRCA2 mutation carriers (see 'Role of the fallopian tube in carcinogenesis' above). Where possible, the entire extrauterine portion of the tube is removed.

This procedure can be accomplished using any surgical route (open, laparoscopic, robotic, or vaginal) and is described in detail separately:

●Open or laparoscopic hysterectomy – (See "Hysterectomy: Abdominal (open) route", section on 'Salpingectomy with ovarian conservation' and "Hysterectomy: Laparoscopic", section on 'Adnexa'.)

●Vaginal hysterectomy – (See "Hysterectomy: Vaginal", section on 'Adnexal evaluation and surgery'.)

●Surgical sterilization – (See "Postpartum permanent contraception: Procedures", section on 'Surgical approach' and "Postpartum permanent contraception: Procedures", section on 'Technique' and "Female interval permanent contraception: Procedures", section on 'Procedure'.)

When laparoscopic salpingectomy is performed, it is not necessary to place normal-appearing fallopian tubes from a patient at average risk of ovarian cancer in a containment bag for removal.

OUTCOMES

Perioperative outcomes

●Operative time – OS does not appear to substantively increase operative time [69-74]. In a population-based study in British Columbia including over 12,000 patients undergoing hysterectomy with or without bilateral salpingectomy, salpingectomy added an average of 16 minutes to the total operative time (133 versus 117 minutes [mean]) [75]. Similarly, for the almost 15,000 patients undergoing sterilization with either tubal ligation or complete salpingectomy, salpingectomy added an average of 10 minutes to the total operative time (71 versus 61 minutes [mean]). By contrast, in a subsequent cohort study including 4183 patients undergoing laparoscopic hysterectomy with or without salpingectomy, total operative time was reduced by five minutes in the salpingectomy group (154 versus 147 minutes [median]) [76]. In at least one study, salpingectomy at the time of cesarean birth was performed in approximately five minutes by experienced surgeons using the mesosalpinx isolation salpingectomy technique [77].

●Blood loss – OS also does not appear to substantively increase blood loss, as assessed through estimated blood loss, change in hemoglobin levels, and need for transfusion. In the large cohort study mentioned above, while patients undergoing hysterectomy (any route) with salpingectomy compared with hysterectomy alone had lower estimated blood loss (100 versus 150 mL [median]), this may have been due to lower blood loss in laparoscopic procedures or selection of less complicated cases for salpingectomy [76].

●Length of hospital stay – Length of hospital stay appears to be similar [78] or even reduced [69,72,75,76] for patients undergoing OS compared with hysterectomy alone.

●Perioperative complications – Perioperative complications also appear to be similar. In a large retrospective study including over 49,000 patients undergoing hysterectomy with or without salpingectomy or sterilization with tubal ligation or complete salpingectomy, rates of minor complications (eg, infection, hospital visits, laboratory tests ordered, imaging required) two weeks after hospital discharge were similar between groups [79]. However, more patients in the OS group filled a prescription for an analgesic during this time.

In a systematic review including seven randomized trials (350 patients) undergoing hysterectomy with or without OS, the number of surgery-related adverse events was too low to detect any difference [80]. To our knowledge, no studies have reported an increase in perioperative complications with OS as compared with hysterectomy alone or tubal ligation.

Ovarian cancer risk reduction — Complete salpingectomy is associated with a decreased risk of developing epithelial ovarian carcinoma (EOC) [81]. In a meta-analysis including three studies evaluating the impact of bilateral salpingectomy on EOC prevention over an 18- to 36-year (mean) follow-up period, patients with a history of prophylactic bilateral salpingectomy (3509 patients) versus no salpingectomy (5,655,702 patients) had an almost 50 percent lower risk of developing EOC (odds ratio 0.51, 95% CI 0.35-0.75) when results were adjusted for study size [82]. The absolute rates of EOC were similarly low in both groups (0.8 and 0.7 percent, respectively).

In a subsequent cohort study including 57,969 patients (mean age 38.2 to 40.2 years) comparing patients undergoing OS (45 percent of patients) with those undergoing hysterectomy or tubal ligation alone, OS was associated with a lower rate of serous (0 versus 15 patients) and epithelial (≤5 versus 21 patients) cancers during the 1.6 to 8.7 years of follow-up [83]. This was also lower than the age-adjusted expected rate of serous (5.27) and epithelial (8.68) cancers. As the observed and expected numbers of breast and colorectal cancers were similar, the difference in observed and expected ovarian cancers were likely not driven by differences between the groups.

In the systematic review of randomized trials discussed above (see 'Perioperative outcomes' above), none of the included studies specifically reported on the incidence of ovarian carcinoma after hysterectomy with or without OS [80].

Assessment of the effectiveness of OS for prevention of EOC is ongoing and requires that enough patients undergo the procedure for the purpose of primary ovarian cancer prevention and that these patients have enough follow-up time to develop ovarian cancers below the expected rate. It will likely take longer to demonstrate an impact for the cohort of patients who undergo salpingectomy for sterilization purposes, as the average age of salpingectomy for sterilization is 36.3 years [84], more than 20 years younger than the average age of diagnosis for nongenetic ovarian cancer [85]. As such, the impact of salpingectomy in ovarian cancer prevention and on histologic distribution of ovarian cancers will be the focus of the ongoing long-term study in British Columbia.

Ovarian function — It is uncertain whether salpingectomy impacts ovarian blood supply and hormonal function (eg, ovarian reserve, age of menopause). While hysterectomy is known to be associated with earlier menopause, this effect is not well understood. (See "Hysterectomy (benign indications): Patient-important issues and surgical complications", section on 'Decreased ovarian function or earlier menopause'.)

Some data suggest that tubal ligation [86-91] and bilateral salpingectomy [92,93] decrease ovarian reserve. For example, in a retrospective study including 6892 patients, those undergoing hysterectomy with or without bilateral salpingectomy had an increased risk of menopausal symptoms one year after surgery (31 versus 24 percent, adjusted relative risk 1.33, 95% CI 1.04-1.69) [94].

However, other data do not show an impact on ovarian reserve [74,95,96]. In the systematic review of randomized trials discussed above (see 'Perioperative outcomes' above), patients undergoing hysterectomy with or without OS had similar onset of menopause [80]. While mean postoperative anti-müllerian hormone (AMH) levels were lower in the OS group (1.89 to 0.01 pmol/L lower), this corresponds to the natural decline of AMH concentration of approximately 6 to 20 months, depending on age. Similarly, a large population-based retrospective cohort study including over 41,000 patients <50 years who underwent either OS with hysterectomy (compared with hysterectomy alone) or OS for sterilization (compared with tubal ligation) and followed for ≥5 years reported no evidence of an earlier age of onset of menopause among those undergoing OS compared with the relevant control groups (hysterectomy alone or tubal ligation) [84].

UTILIZATION — There has been an increased global acceptance of OS since its introduction as a potential ovarian cancer risk reduction strategy in 2010. While Canada was the first country to recommend consideration of OS during benign gynecologic surgery, by 2018 there were ten countries (Canada, Finland, United States, Great Britain, Australia, New Zealand, Denmark, Turkey, Austria, Japan) with International Federation of Obstetrics and Gynecology (FIGO) statements supporting OS [97]. In addition, four countries (Germany, Sweden, Norway, France) included ambivalent statements that addressed the subject but did not recommend for or against the procedure.

Utilization of the procedure is therefore increasing [75,98-103]. In a retrospective population-based cohort study in the United States including over one million patients undergoing hysterectomy for benign indications, rates of OS increased from 2.4 to 5.7 percent (between 2001 and 2010) to 58.4 percent by 2015; the rapid increase occurred after publication of data implicating the fallopian tubes in the pathogenesis of ovarian cancer [102]. In the large retrospective study of a large health care system discussed above (see 'Perioperative outcomes' above), higher rates (73 percent in 2014) were reported and salpingectomy was more common during laparoscopic hysterectomy compared with other routes [76]. Physicians reported the most important barriers to performing OS included: difficulty in accessing the fallopian tube, concern for increased complications, forgetting to address this issue preoperatively, and limited evidence to support its use.

SUMMARY AND RECOMMENDATIONS

●Definition – Opportunistic salpingectomy (OS) is the removal of the fallopian tubes for primary prevention of epithelial carcinoma of the fallopian tube, ovary, or peritoneum in average-risk patients undergoing pelvic surgery for another indication. By contrast, risk-reducing bilateral salpingo-oophorectomy (rrBSO) is a procedure performed in patients at high risk for these cancers. (See 'Introduction' above.)

●Rationale for performing this procedure

•Epithelial carcinoma of the ovary, fallopian tube, and peritoneum are considered a single entity and referred to collectively as epithelial ovarian carcinoma (EOC). While historically the ovaries were regarded as the most common primary sites of these cancers, data suggest that the majority of these cancers actually arise from the epithelium of the distal fallopian tube. (See 'Role of the fallopian tube in carcinogenesis' above.)

•Tubal ligation has consistently been shown to decrease the risk of developing EOC, providing additional support for the role of the fallopian tube in ovarian carcinoma pathogenesis. (See 'Efficacy of tubal ligation in cancer reduction' above.)

•In general, EOC presents at an advanced stage and has a poor prognosis (table 1). There are also no effective screening methods for these cancers. Thus, OS was proposed to reduce the risk of developing these cancers. (See 'Other' above.)

●Candidates – OS is appropriate for patients of any age who have no plans for future pregnancy. Patients at high risk for EOC (eg, BRCA gene mutation, Lynch syndrome) are not candidates for OS and rather should undergo a rrBSO. (See 'Candidates' above.)

●Counseling – The most common eligible procedures are hysterectomy for benign indications and sterilization. (See 'Counseling' above.)

•For most patients who undergo hysterectomy with ovarian conservation, we suggest performing bilateral salpingectomy (Grade 2C). For patients undergoing vaginal hysterectomy, removal of the tubes is feasible with a transvaginal approach or can be performed with laparoscopic assistance. We do not change the surgical route to be able to perform OS unless this is the strong preference of the patient.

•For patients undergoing surgical sterilization, we discuss all options for sterilization, including complete salpingectomy, and communicate that sterilization by salpingectomy is not reversible. We share the available data regarding minimal added surgical time and risk of morbidity. We offer OS for permanent sterilization via laparoscopy or laparotomy, and at the time of cesarean birth.

●Outcomes – The risks of salpingectomy appear to be minimal. Removal of the tube appears to add little to no time to the duration of hysterectomy or sterilization and appears to have no effect on morbidity. The impact of salpingectomy on ovarian function remains uncertain. (See 'Outcomes' above.)

ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges Dianne M Miller, MD, FRCSC, who contributed to earlier versions of this topic review.

Homepage. OVCARE. Available at: www.ovcare.ca (Accessed on September 08, 2021).
Crum CP, Drapkin R, Kindelberger D, et al. Lessons from BRCA: the tubal fimbria emerges as an origin for pelvic serous cancer. Clin Med Res 2007; 5:35.
Crum CP, Drapkin R, Miron A, et al. The distal fallopian tube: a new model for pelvic serous carcinogenesis. Curr Opin Obstet Gynecol 2007; 19:3.
Piek JM, van Diest PJ, Zweemer RP, et al. Dysplastic changes in prophylactically removed Fallopian tubes of women predisposed to developing ovarian cancer. J Pathol 2001; 195:451.
Tobacman JK, Greene MH, Tucker MA, et al. Intra-abdominal carcinomatosis after prophylactic oophorectomy in ovarian-cancer-prone families. Lancet 1982; 2:795.
Piver MS, Jishi MF, Tsukada Y, Nava G. Primary peritoneal carcinoma after prophylactic oophorectomy in women with a family history of ovarian cancer. A report of the Gilda Radner Familial Ovarian Cancer Registry. Cancer 1993; 71:2751.
Struewing JP, Watson P, Easton DF, et al. Prophylactic oophorectomy in inherited breast/ovarian cancer families. J Natl Cancer Inst Monogr 1995; :33.
Powell CB, Chen LM, McLennan J, et al. Risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation carriers: experience with a consecutive series of 111 patients using a standardized surgical-pathological protocol. Int J Gynecol Cancer 2011; 21:846.
Powell CB, Swisher EM, Cass I, et al. Long term follow up of BRCA1 and BRCA2 mutation carriers with unsuspected neoplasia identified at risk reducing salpingo-oophorectomy. Gynecol Oncol 2013; 129:364.
Reitsma W, de Bock GH, Oosterwijk JC, et al. Support of the 'fallopian tube hypothesis' in a prospective series of risk-reducing salpingo-oophorectomy specimens. Eur J Cancer 2013; 49:132.
Wethington SL, Park KJ, Soslow RA, et al. Clinical outcome of isolated serous tubal intraepithelial carcinomas (STIC). Int J Gynecol Cancer 2013; 23:1603.
Finch A, Shaw P, Rosen B, et al. Clinical and pathologic findings of prophylactic salpingo-oophorectomies in 159 BRCA1 and BRCA2 carriers. Gynecol Oncol 2006; 100:58.
Medeiros F, Muto MG, Lee Y, et al. The tubal fimbria is a preferred site for early adenocarcinoma in women with familial ovarian cancer syndrome. Am J Surg Pathol 2006; 30:230.
Colgan TJ, Murphy J, Cole DE, et al. Occult carcinoma in prophylactic oophorectomy specimens: prevalence and association with BRCA germline mutation status. Am J Surg Pathol 2001; 25:1283.
Callahan MJ, Crum CP, Medeiros F, et al. Primary fallopian tube malignancies in BRCA-positive women undergoing surgery for ovarian cancer risk reduction. J Clin Oncol 2007; 25:3985.
Gilks CB, Irving J, Köbel M, et al. Incidental nonuterine high-grade serous carcinomas arise in the fallopian tube in most cases: further evidence for the tubal origin of high-grade serous carcinomas. Am J Surg Pathol 2015; 39:357.
Morrison JC, Blanco LZ Jr, Vang R, Ronnett BM. Incidental serous tubal intraepithelial carcinoma and early invasive serous carcinoma in the nonprophylactic setting: analysis of a case series. Am J Surg Pathol 2015; 39:442.
Nishida N, Murakami F, Higaki K. Detection of serous precursor lesions in resected fallopian tubes from patients with benign diseases and a relatively low risk for ovarian cancer. Pathol Int 2016; 66:337.
Rabban JT, Garg K, Crawford B, et al. Early detection of high-grade tubal serous carcinoma in women at low risk for hereditary breast and ovarian cancer syndrome by systematic examination of fallopian tubes incidentally removed during benign surgery. Am J Surg Pathol 2014; 38:729.
Powell CB, Kenley E, Chen LM, et al. Risk-reducing salpingo-oophorectomy in BRCA mutation carriers: role of serial sectioning in the detection of occult malignancy. J Clin Oncol 2005; 23:127.
Kindelberger DW, Lee Y, Miron A, et al. Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: Evidence for a causal relationship. Am J Surg Pathol 2007; 31:161.
Carlson JW, Miron A, Jarboe EA, et al. Serous tubal intraepithelial carcinoma: its potential role in primary peritoneal serous carcinoma and serous cancer prevention. J Clin Oncol 2008; 26:4160.
Seidman JD, Zhao P, Yemelyanova A. "Primary peritoneal" high-grade serous carcinoma is very likely metastatic from serous tubal intraepithelial carcinoma: assessing the new paradigm of ovarian and pelvic serous carcinogenesis and its implications for screening for ovarian cancer. Gynecol Oncol 2011; 120:470.
Salvador S, Rempel A, Soslow RA, et al. Chromosomal instability in fallopian tube precursor lesions of serous carcinoma and frequent monoclonality of synchronous ovarian and fallopian tube mucosal serous carcinoma. Gynecol Oncol 2008; 110:408.
Kauff ND, Domchek SM, Friebel TM, et al. Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: a multicenter, prospective study. J Clin Oncol 2008; 26:1331.
Tang S, Onuma K, Deb P, et al. Frequency of serous tubal intraepithelial carcinoma in various gynecologic malignancies: a study of 300 consecutive cases. Int J Gynecol Pathol 2012; 31:103.
Shaw PA, Rouzbahman M, Pizer ES, et al. Candidate serous cancer precursors in fallopian tube epithelium of BRCA1/2 mutation carriers. Mod Pathol 2009; 22:1133.
McLaughlin JR, Risch HA, Lubinski J, et al. Reproductive risk factors for ovarian cancer in carriers of BRCA1 or BRCA2 mutations: a case-control study. Lancet Oncol 2007; 8:26.
Narod SA, Sun P, Ghadirian P, et al. Tubal ligation and risk of ovarian cancer in carriers of BRCA1 or BRCA2 mutations: a case-control study. Lancet 2001; 357:1467.
McGuire V, Felberg A, Mills M, et al. Relation of contraceptive and reproductive history to ovarian cancer risk in carriers and noncarriers of BRCA1 gene mutations. Am J Epidemiol 2004; 160:613.
Tworoger SS, Fairfield KM, Colditz GA, et al. Association of oral contraceptive use, other contraceptive methods, and infertility with ovarian cancer risk. Am J Epidemiol 2007; 166:894.
Hankinson SE, Hunter DJ, Colditz GA, et al. Tubal ligation, hysterectomy, and risk of ovarian cancer. A prospective study. JAMA 1993; 270:2813.
Falconer H, Yin L, Salehi S, Altman D. Association between pelvic inflammatory disease and subsequent salpingectomy on the risk for ovarian cancer. Eur J Cancer 2021; 145:38.
Rice MS, Hankinson SE, Tworoger SS. Tubal ligation, hysterectomy, unilateral oophorectomy, and risk of ovarian cancer in the Nurses' Health Studies. Fertil Steril 2014; 102:192.
Sieh W, Salvador S, McGuire V, et al. Tubal ligation and risk of ovarian cancer subtypes: a pooled analysis of case-control studies. Int J Epidemiol 2013; 42:579.
Gaitskell K, Coffey K, Green J, et al. Tubal ligation and incidence of 26 site-specific cancers in the Million Women Study. Br J Cancer 2016; 114:1033.
Gaitskell K, Green J, Pirie K, et al. Tubal ligation and ovarian cancer risk in a large cohort: Substantial variation by histological type. Int J Cancer 2016; 138:1076.
Falconer H, Yin L, Grönberg H, Altman D. Ovarian cancer risk after salpingectomy: a nationwide population-based study. J Natl Cancer Inst 2015; 107.
Madsen C, Baandrup L, Dehlendorff C, Kjaer SK. Tubal ligation and salpingectomy and the risk of epithelial ovarian cancer and borderline ovarian tumors: a nationwide case-control study. Acta Obstet Gynecol Scand 2015; 94:86.
Rice MS, Murphy MA, Vitonis AF, et al. Tubal ligation, hysterectomy and epithelial ovarian cancer in the New England Case-Control Study. Int J Cancer 2013; 133:2415.
Sandoval C, Fung-Kee-Fung M, Gilks B, et al. Examining the use of salpingectomy with hysterectomy in Canada. Curr Oncol 2013; 20:173.
Tone AA, Salvador S, Finlayson SJ, et al. The role of the fallopian tube in ovarian cancer. Clin Adv Hematol Oncol 2012; 10:296.
Garrett LA, Growdon WB, Goodman A, et al. Endometriosis-associated ovarian malignancy: a retrospective analysis of presentation, treatment, and outcome. J Reprod Med 2013; 58:469.
Wiegand KC, Hennessy BT, Leung S, et al. A functional proteogenomic analysis of endometrioid and clear cell carcinomas using reverse phase protein array and mutation analysis: protein expression is histotype-specific and loss of ARID1A/BAF250a is associated with AKT phosphorylation. BMC Cancer 2014; 14:120.
Wiegand KC, Shah SP, Al-Agha OM, et al. ARID1A mutations in endometriosis-associated ovarian carcinomas. N Engl J Med 2010; 363:1532.
Bruckner HW, Cohen CJ, Goldberg JD, et al. Cisplatin regimens and improved prognosis of patients with poorly differentiated ovarian cancer. Am J Obstet Gynecol 1983; 145:653.
Vogl SE, Pagano M, Kaplan BH, et al. Cis-platin based combination chemotherapy for advanced ovarian cancer. High overall response rate with curative potential only in women with small tumor burdens. Cancer 1983; 51:2024.
Bristow RE, Chang J, Ziogas A, et al. High-volume ovarian cancer care: survival impact and disparities in access for advanced-stage disease. Gynecol Oncol 2014; 132:403.
The Cheryl Brown Ovarian Cancer Outcomes Unit. OVCARE. Available at: http://www.ovcare.ca/research/the_cheryl_brown_ovarian_cancer_outcomes_unit/ (Accessed on October 23, 2016).
http://www.bccancer.bc.ca/HPI/CancerStatistics/default.htm (Accessed on October 23, 2016).
Moore K, Colombo N, Scambia G, et al. Maintenance Olaparib in Patients with Newly Diagnosed Advanced Ovarian Cancer. N Engl J Med 2018; 379:2495.
González-Martín A, Pothuri B, Vergote I, et al. Niraparib in Patients with Newly Diagnosed Advanced Ovarian Cancer. N Engl J Med 2019; 381:2391.
Coleman RL, Fleming GF, Brady MF, et al. Veliparib with First-Line Chemotherapy and as Maintenance Therapy in Ovarian Cancer. N Engl J Med 2019; 381:2403.
Ray-Coquard I, Pautier P, Pignata S, et al. Olaparib plus Bevacizumab as First-Line Maintenance in Ovarian Cancer. N Engl J Med 2019; 381:2416.
Menon U, Gentry-Maharaj A, Burnell M, et al. Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet 2021; 397:2182.
Kobayashi H, Yamada Y, Sado T, et al. A randomized study of screening for ovarian cancer: a multicenter study in Japan. Int J Gynecol Cancer 2008; 18:414.
Menon U, Gentry-Maharaj A, Hallett R, et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol 2009; 10:327.
Menon U, Kalsi J, Jacobs I. The UKCTOCS experience--reasons for hope? Int J Gynecol Cancer 2012; 22 Suppl 1:S18.
Buys SS, Partridge E, Black A, et al. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA 2011; 305:2295.
Buys SS, Partridge E, Greene MH, et al. Ovarian cancer screening in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial: findings from the initial screen of a randomized trial. Am J Obstet Gynecol 2005; 193:1630.
Harmsen MG, Arts-de Jong M, Hoogerbrugge N, et al. Early salpingectomy (TUbectomy) with delayed oophorectomy to improve quality of life as alternative for risk-reducing salpingo-oophorectomy in BRCA1/2 mutation carriers (TUBA study): a prospective non-randomised multicentre study. BMC Cancer 2015; 15:593.
Lugo Santiago N, Smith E, Cox M, et al. Ovarian Cancer After Prophylactic Salpingectomy in a Patient With Germline BRCA1 Mutation. Obstet Gynecol 2020; 135:1270.
GOC Evidentiary Statement https://www.g-o-c.org/uploads/11sept15_gocevidentiarystatement_final_en.pdf (Accessed on June 24, 2014).
SGO Clinical Practice Statement https://www.sgo.org/clinical-practice/guidelines/sgo-clinical-practice-statement-salpingectomy-for-ovarian-cancer-prevention/ (Accessed on June 24, 2014).
Committee on Gynecologic Practice. Committee opinion no. 620: Salpingectomy for ovarian cancer prevention. Obstet Gynecol 2015; 125:279. Reaffirmed July 2017.
Pölcher M, Hauptmann S, Fotopoulou C, et al. Opportunistic salpingectomies for the prevention of a high-grade serous carcinoma: a statement by the Kommission Ovar of the AGO. Arch Gynecol Obstet 2015; 292:231.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Managing the adnexae at hysterectomy for benign disease. July, 2009 (reviewed July, 2014).
Tomasch G, Lemmerer M, Oswald S, et al. Prophylactic salpingectomy for prevention of ovarian cancer at the time of elective laparoscopic cholecystectomy. Br J Surg 2020; 107:519.
Ghezzi F, Cromi A, Siesto G, et al. Infectious morbidity after total laparoscopic hysterectomy: does concomitant salpingectomy make a difference? BJOG 2009; 116:589.
Morelli M, Venturella R, Mocciaro R, et al. Prophylactic salpingectomy in premenopausal low-risk women for ovarian cancer: primum non nocere. Gynecol Oncol 2013; 129:448.
Vorwergk J, Radosa MP, Nicolaus K, et al. Prophylactic bilateral salpingectomy (PBS) to reduce ovarian cancer risk incorporated in standard premenopausal hysterectomy: complications and re-operation rate. J Cancer Res Clin Oncol 2014; 140:859.
Minig L, Chuang L, Patrono MG, et al. Surgical outcomes and complications of prophylactic salpingectomy at the time of benign hysterectomy in premenopausal women. J Minim Invasive Gynecol 2015; 22:653.
Findley AD, Siedhoff MT, Hobbs KA, et al. Short-term effects of salpingectomy during laparoscopic hysterectomy on ovarian reserve: a pilot randomized controlled trial. Fertil Steril 2013; 100:1704.
Song T, Kim MK, Kim ML, et al. Impact of opportunistic salpingectomy on anti-Müllerian hormone in patients undergoing laparoscopic hysterectomy: a multicentre randomised controlled trial. BJOG 2017; 124:314.
McAlpine JN, Hanley GE, Woo MM, et al. Opportunistic salpingectomy: uptake, risks, and complications of a regional initiative for ovarian cancer prevention. Am J Obstet Gynecol 2014; 210:471.e1.
Garcia C, Martin M, Tucker LY, et al. Experience With Opportunistic Salpingectomy in a Large, Community-Based Health System in the United States. Obstet Gynecol 2016; 128:277.
Guo XM, Hall EF, Mazzullo L, Djordjevic M. A low-cost approach to salpingectomy at cesarean delivery. Am J Obstet Gynecol 2020; 222:503.e1.
Kho RM, Wechter ME. Operative Outcomes of Opportunistic Bilateral Salpingectomy at the Time of Benign Hysterectomy in Low-Risk Premenopausal Women: A Systematic Review. J Minim Invasive Gynecol 2017; 24:218.
Hanley GE, Kwon JS, Finlayson SJ, et al. Extending the safety evidence for opportunistic salpingectomy in prevention of ovarian cancer: a cohort study from British Columbia, Canada. Am J Obstet Gynecol 2018; 219:172.e1.
van Lieshout LAM, Steenbeek MP, De Hullu JA, et al. Hysterectomy with opportunistic salpingectomy versus hysterectomy alone. Cochrane Database Syst Rev 2019; 8:CD012858.
Kahn RM, Gordhandas S, Godwin K, et al. Salpingectomy for the Primary Prevention of Ovarian Cancer: A Systematic Review. JAMA Surg 2023; 158:1204.
Yoon SH, Kim SN, Shim SH, et al. Bilateral salpingectomy can reduce the risk of ovarian cancer in the general population: A meta-analysis. Eur J Cancer 2016; 55:38.
Hanley GE, Pearce CL, Talhouk A, et al. Outcomes From Opportunistic Salpingectomy for Ovarian Cancer Prevention. JAMA Netw Open 2022; 5:e2147343.
Hanley GE, Kwon JS, McAlpine JN, et al. Examining indicators of early menopause following opportunistic salpingectomy: a cohort study from British Columbia, Canada. Am J Obstet Gynecol 2020; 223:221.e1.
Canadian Cancer Society: Risk factors for ovarian cancer http://www.cancer.ca/en/cancer-information/cancer-type/ovarian/risks/?region=on (Accessed on March 28, 2014).
DeStefano F, Huezo CM, Peterson HB, et al. Menstrual changes after tubal sterilization. Obstet Gynecol 1983; 62:673.
Garza-Flores J, Vázquez-Estrada L, Reyes A, et al. Assessment of luteal function after surgical tubal sterilization. Adv Contracept 1991; 7:371.
Dede FS, Dilbaz B, Akyuz O, et al. Changes in menstrual pattern and ovarian function following bipolar electrocauterization of the fallopian tubes for voluntary surgical contraception. Contraception 2006; 73:88.
Nelson DB, Sammel MD, Freeman EW, et al. Tubal ligation does not affect hormonal changes during the early menopausal transition. Contraception 2005; 71:104.
Dede FS, Akyuz O, Dilbaz B, et al. Color doppler flow analysis of uterine and ovarian arteries before and after tubal sterilization: electrocautery versus pomeroy. Gynecol Obstet Invest 2006; 61:45.
Geber S, Caetano JP. Doppler colour flow analysis of uterine and ovarian arteries prior to and after surgery for tubal sterilization: a prospective study. Hum Reprod 1996; 11:1195.
Reade CJ, Finlayson S, McAlpine J, et al. Risk-reducing salpingectomy in Canada: a survey of obstetrician-gynaecologists. J Obstet Gynaecol Can 2013; 35:627.
Ye XP, Yang YZ, Sun XX. A retrospective analysis of the effect of salpingectomy on serum antiMüllerian hormone level and ovarian reserve. Am J Obstet Gynecol 2015; 212:53.e1.
Collins E, Strandell A, Granåsen G, Idahl A. Menopausal symptoms and surgical complications after opportunistic bilateral salpingectomy, a register-based cohort study. Am J Obstet Gynecol 2019; 220:85.e1.
Tehranian A, Zangbar RH, Aghajani F, et al. Effects of salpingectomy during abdominal hysterectomy on ovarian reserve: a randomized controlled trial. Gynecol Surg 2017; 14:17.
Van Lieshout LAM, Pijlman B, Vos MC, et al. Opportunistic salpingectomy in women undergoing hysterectomy: Results from the HYSTUB randomised controlled trial. Maturitas 2018; 107:1.
Ntoumanoglou-Schuiki A, Tomasch G, Laky R, et al. Opportunistic prophylactic salpingectomy for prevention of ovarian cancer: What do national societies advise? Eur J Obstet Gynecol Reprod Biol 2018; 225:110.
Mikhail E, Salemi JL, Mogos MF, et al. National trends of adnexal surgeries at the time of hysterectomy for benign indication, United States, 1998-2011. Am J Obstet Gynecol 2015; 213:713.e1.
Kapurubandara S, Qin V, Gurram D, et al. Opportunistic bilateral salpingectomy during gynaecological surgery for benign disease: A survey of current Australian practice. Aust N Z J Obstet Gynaecol 2015; 55:606.
Venturella R, Rocca M, Lico D, et al. Prophylactic bilateral salpingectomy for the prevention of ovarian cancers: What is happening in Italy? Eur J Cancer Prev 2016; 25:410.
Hicks-Courant KD. Growth in salpingectomy rates in the United States since 2000. Am J Obstet Gynecol 2016; 215:666.
Mandelbaum RS, Adams CL, Yoshihara K, et al. The rapid adoption of opportunistic salpingectomy at the time of hysterectomy for benign gynecologic disease in the United States. Am J Obstet Gynecol 2020; 223:721.e1.
Hanley GE, Niu J, Han J, et al. Opportunistic salpingectomy between 2011 and 2016: a descriptive analysis. CMAJ Open 2022; 10:E466.

Topic 91886 Version 22.0

خرید پکیج

Opportunistic salpingectomy for ovarian, fallopian tube, and peritoneal carcinoma risk reduction

References