Salpingectomy May Prevent Ovarian Cancer, ACOG Says

Veronica Hackethal, MD

December 31, 2014

Removal of the fallopian tubes may help prevent ovariancancer, according to an opinion written by the American Collegeof Obstetricians and Gynecologists' Committee on Gynecologic Practice. Theopinion appearsin the January 2015 issue of Obstetrics & Gynecology.

"Salpingectomy at the time of hysterectomy or as ameans of tubal sterilization appears to be safe, without an increase incomplications...compared with hysterectomy alone or tubal ligation," thecommittee writes.

"Counseling women who are undergoing routine pelvicsurgery about the risks and benefits of salpingectomy should include aninformed consent discussion about the role of oophorectomy and bilateralsalpingo-oophorectomy."

The opinion specifically addresses women at"population risk" for ovarian cancer, meaning women who do not havean elevated genetic risk for ovarian cancer but who are having routine pelvicsurgery for benign disease.

Among gynecologic cancers, ovarian cancer carries thehighest mortality rate; it ranks as the fifth leading cause of death fromcancer in women, the authors note. The survival rate for ovarian cancer has notimproved much during the last 50 years.

The committee made the following recommendations:

·        In women at population risk forovarian cancer, surgeons should discuss the potential benefits ofsalpingectomy.

·        In women consideringlaparoscopic sterilization, physicians can discuss the fact that bilateralsalpingectomy provides effective contraception, while pointing out that thisprocedure eliminates the option of tubal reversal.

·        Prophylactic salpingectomy mayprevent ovarian cancer in some patients.

·        More randomized controlledtrials are needed to support the use of salpingectomy in reducing ovariancancer.

The committee urges surgeons to continue to use minimallyinvasive techniques. For now, the possible benefit of salpingectomy should notsway decisions about which technique to use for hysterectomy and sterilization.For example, the committee advises surgeons not to switch from vaginal tolaparoscopic hysterectomy simply to do a salpingectomy.

The committee cited various studies to back up its opinion.About 75% of ovarian cancers and 90% of deaths from ovarian cancer result fromepithelial ovarian cancer, they write. In contrast to traditional views thatepithelial ovarian cancer arises from elements of the ovaries, recent researchsuggests that epithelial ovarian cancer derives from elements of the fallopiantube and endometrium.

Research has also pointed to a protective effect of tuballigation against endometrioid and clear cell carcinomas, suggesting thesetumors may arise from retrograde menses.

On the basis of current views about ovarian carcinogenesis,the committee continues, salpingectomy while leaving the ovaries intact may bebetter for cancer prevention than oophorectomy and bilateral salpingo-oophorectomy.The latter techniques can cause early menopause and increased risk forcardiovascular disease, osteoporosis, and cognitive impairment and were alsolinked to increased risk for all-cause and cancer specific mortality in theNurses' Health Study.

Obstet Gynecol.2015;125:279-281.