Salpingectomy may offer clinicians the chance to prevent ovarian cancer, according to a policy statement from the American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice, published in Obstetrics and Gynecology on Dec. 22.
Ovarian cancer carries the highest mortality of any gynecologic cancer and is the fifth-leading cause of cancer deaths among women. Overall survival has improved only marginally in the last 50 years, and current attempts at screening are not only unsuccessful but have led to unnecessary surgery and associated complications. The new ACOG committee opinion advises physicians to consider prophylactic salpingectomy as part of a prevention strategy.
The first step for physicians is to discuss salpingectomy with women who are scheduled to undergo routine pelvic surgery, such as tubal sterilization or hysterectomy without oophorectomy. Performing concurrent salpingectomy does not appear to increase complications, compared with tubal ligation or hysterectomy alone, and doesn’t appear to affect ovarian function.
“Given current theories of ovarian carcinogenesis, ovarian conservation and salpingectomy may represent a better option than [bilateral salpingo-oophorectomy] for ovarian cancer risk reduction for most women undergoing other pelvic surgeries for benign disease,” ACOG wrote in the committee opinion (Obstet. Gynecol. 2015;125:279-81).
But the ACOG committee advised physicians to discuss the role of oophorectomy and bilateral salpingo-oophorectomy as part the informed consent discussion.
Salpingectomy also should be discussed when counseling women about laparoscopic sterilization methods since it can be considered a method that provides effective contraception, according to the committee opinion.
Surgeons, however, should not change their approach to hysterectomy or sterilization just because of the “theoretical benefit of salpingectomy,” the committee wrote.
“A vaginal hysterectomy should not be changed to a laparoscopic hysterectomy simply to perform a salpingectomy,” ACOG wrote. “The choice of sterilization procedure should be based on the risks and benefits of the hysteroscopic and laparoscopic approaches.”
The opinion statement also noted that salpingectomy should be performed with “meticulous attention.” The entire fallopian tube should be removed, from the fimbriated end to the uterotubal junction, and any fimbrial attachments on the ovary should be cauterized or removed. “Care should be taken not to interrupt the blood supply to the ovary through the infundibulopelvic ligament because the collateral vasculature from the tubal mesosalpinx is occluded during tube removal.”
And in cases when complete salpingectomy cannot be accomplished, removing as much of the fallopian tubes as possible “still may have value,” ACOG wrote.