Evidence - Salpingectomy, laparoscopic, robot-assisted laparoscopy (DaVinci)

• Opportunistic salpingectomy
• Sterilization
• Therapeutic salpingectomy

Opportunistic salpingectomy, also an oncological prophylactic salpingectomy for ovarian cancer reduction. Approximately 7,000 women are diagnosed with ovarian cancer annually in Germany. In most cases, the cancer is detected at an advanced stage (FIGO III-IV, about 70%), resulting in a poor prognosis. Additionally, there is no good early detection method.

In 2010, the British Columbia Ovarian Cancer Research (OVCARE) team proposed prophylactic salpingectomy as a strategy for primary prevention of ovarian cancer, based on the following observations:

• Carcinogenesis: Most ovarian carcinomas, especially high-grade serous carcinoma, originate from the epithelium of the distal fallopian tube and not from the ovary itself.
• In patients at high risk for ovarian cancer (e.g., patients with BRCA1 and BRCA2 mutations), a risk-reducing bilateral salpingo-oophorectomy was performed, where occult fallopian tube carcinomas and/or premalignant lesions were found in the fallopian tube, which could not be found in the ovary.
• Premalignant lesions were also found in the fallopian tubes of patients with average risk. Here, a salpingectomy was performed for benign reasons, such as sterilization or hysterectomy.
• It was shown that the involvement of the fallopian tubes was up to 75 percent in patients diagnosed with ovarian or primary peritoneal serous carcinoma (with and without BRCA mutations), including the presence of fimbrial precancers up to 60 percent.
• Tubal ligation can also reduce the risk of ovarian cancer, with large retrospective studies showing a greater risk reduction for non-serous histologies (particularly endometrioid and clear cell carcinomas).

Mechanisms of risk reduction:

• Removal of the initial site of carcinogenesis (high-grade serous carcinomas)
• Removal of the tube for the passage of endometriotic or endosalpingiotic cells (clear cell and endometrioid carcinomas)
• Removal of the tube for the passage of carcinogens (e.g., talc) or inflammation (e.g., pelvic infection) before reaching the ovary.

The indication for bilateral opportunistic salpingectomy should only be made for patients undergoing pelvic surgery for another reason (e.g., hysterectomy for benign disease, permanent sterilization) and who have completed family planning. In patients at high risk for cancers of the fallopian tube, ovary, and peritoneum (e.g., BRCA gene mutation, Lynch syndrome), a risk-reducing bilateral salpingo-oophorectomy should be considered after a benefit-risk assessment.

Many studies have examined the perioperative course after an opportunistic salpingectomy:

• Extension of surgery time by about 10-16 minutes
• Blood loss: no difference
• Hospital stay: no difference
• Perioperative complications (infections, blood draws, rounds, further diagnostics): no difference
• Menopause: Onset of menopause was the same in both groups. However, one study showed that the Anti-Müllerian hormone was slightly lower in the salpingectomy group.

Risk reduction of developing ovarian cancer:

A meta-analysis showed that with a follow-up period of 18-36 years, a prophylactic bilateral salpingectomy versus no salpingectomy reduced the risk by almost 50 percent adjusted to the study population. Overall, the risk of developing ovarian cancer was very low in both groups (0.8 and 0.7 percent, respectively).

Reference:

1. Center for Cancer Registry Data: Ovarian Cancer (Ovarian Carcinoma). www.krebsdaten.de/Krebs/DE/Content/Krebsarten/Eierstockkrebs/eierstockkrebs_node.html (last accessed on 7 February 2022).
2. Homepage. OVCARE. Available at: www.ovcare.ca (Accessed on September 08, 2021).
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