Menopausal symptoms and surgical complications after opportunistic bilateral salpingectomy, a register-based cohort study

Abstract

BACKGROUND: In recent years, the fallopian tubes have been found to play a critical role in the pathogenesis of ovarian cancer. Therefore, bilateral salpingectomy at the time of hysterectomy has been proposed as a preventive procedure, but with scarce scientific evidence to support the efficiency and safety. OBJECTIVE: Our primary objective was to evaluate the risk of surgical complications and menopausal symptoms when performing bilateral salpingectomy in addition to benign hysterectomy. Furthermore, we sought to compare time in surgery, perioperative blood loss/blood transfusion, duration of hospital stay, days to normal activities of daily living, and days out of work for hysterectomy with bilateral salpingectomy compared with hysterectomy only. A secondary objective was to study the uptake of opportunistic salpingectomy in Sweden. STUDY DESIGN: This was a retrospective observational cohort study based on data from the National Quality Register of Gynecological Surgery in Sweden. Women <55 years of age who had a hysterectomy for benign indications with or without bilateral salpingectomy in 1998 through 2016 were included. Possible confounding was adjusted for in multivariable regression models. RESULTS: During the study period, 23,369 women had a hysterectomy for benign indications. The frequency of bilateral salpingectomy at the time of hysterectomy increased mainly from 2013, which is why the period 2013 through mid-2016 was selected for further analysis (n ¼ 6892). There was a low frequency of vaginal hysterectomy with bilateral salpingectomy performed in this period, which is why only abdominal and laparoscopic surgeries were selected for comparative analysis (n ¼ 4906). This study indicates an increased risk of menopausal symptoms (adjusted relative risk, 1.33; 95% confidence interval, 1.04e1.69) 1 year after hysterectomy with bilateral salpingectomy compared with hysterectomy only. Hospital stay was 0.1 days longer in women having salpingectomy (P ¼ .01), and bleeding was slightly reduced in the salpingectomy group (e20 mL, P ¼ .04). Other outcome measures were not significantly associated with salpingectomy, albeit a tendency toward higher risk of minor complications was seen (adjusted relative risk, 1.30; 95% confidence interval, 0.93e1.83). CONCLUSION: Bilateral salpingectomy at the time of hysterectomy was associated with an increased risk of menopausal symptoms 1 year after surgery. Randomized clinical trials reducing the risk of residual and unmeasured confounding and longer follow-up are needed to correctly inform women on the risks and benefits of opportunistic salpingectomy.

Examining indicators of early menopause following opportunistic salpingectomy: a cohort study from British Columbia, Canada

“…28 Our results conflict with a recent Swedish study in which women who underwent OS at the time of hysterectomy reported more menopausal symptoms 1 year after surgery than women who underwent hysterectomy alone. 29 If women in our cohort were experiencing menopausal symptoms differently according to OS status, they were not significant enough to change their care-seeking behaviors.…”

“…28 However, a recent Swedish Registry study found an increased risk of menopausal symptoms 1 year after hysterectomy among women who underwent hysterectomy with bilateral salpingectomy compared with hysterectomy alone (relative risk, 1.33; 95% confidence interval [CI], 1.04e1.69). 29 Given that an earlier age at menopause has been associated with increased mortality rates, 30e32 it is imperative that we understand whether OS decreases the age of onset of menopause. Herein, we use population-based data in British Columbia, Canada, to examine indicators of menopause, namely physician visits for menopause or the initiation of hormone replacement therapy (HRT) among women who undergo OS and women who undergo comparator surgeries.…”

Contemporary Issues in Women's Health

“…A Swedish group recently published a retrospective observational cohort study using data from the National Quality Register of Gynecological Surgery in Sweden . The principal objective was to assess the likelihood of surgical complications and menopausal symptoms when performing bilateral salpingectomy as well as benign hysterectomy.…”

Bridging different realities - a qualitative study on patients’ experiences of preoperative care for benign hysterectomy and opportunistic salpingectomy in Sweden

“…This has led to the introduction of the term "opportunistic salpingectomy", which is the removal of presumed healthy fallopian tubes at the time of other benign intra-abdominal surgery with ovarian preservation, with the aim of potentially preventing ovarian cancer [10]. Opportunistic salpingectomy at the time of hysterectomy for benign indication is considered feasible which is noted as a widespread uptake of the procedure around the world [10][11][12][13][14][15]. In spite of this apparent acceptance in clinical practice there is still no consensus.…”