Opportunistic salpingectomy at benign gynecological surgery for reducing ovarian cancer risk: a 10-year single centre experience from China and a literature review

Abstract

Current evidences indicate that the fallopian tube plays a major role in the pathogenesis of epithelial ovarian cancer (EOC). Salpingectomy represents a novel and potentially effective risk-reducing option. In this study, there were 1822 patients diagnosed and treated for EOC or primary peritoneal cancer (PPC) at Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital from January 1, 2007 to April 30, 2017. Among them, 198 patients with a history of gynecological surgery because of benign diseases were enrolled to analyze further. Using 1:2 case-control study, we found that the incidence of EOC was significantly decreased in the population with salpingectomy, compared to women with fallopian tube reserved (P<0.05). At the same period, there were 4339 patients receiving opportunistic salpingectomy in our centre because of benign gynecological diseases. The results showed the rate of bilateral salpingectomy was annually increased from 2007 to 2017 (22.02% to 60.22%), which showed approximately threefold increase in a decade. In general, factors affecting the rate of salpingectomy included age, child number, menopause or not, marital status, educational status, income status, and with or without family history of tumor. Therefore, based on ten years experiences from our centre, it is recommended that physician should discuss with appropriate patients to perform opportunistic bilateral salpingectomy at the time of receiving benign gynecological surgery for preventing ovarian cancer. Moreover, the prospective, large scale and multi-centre studies to evaluate the safety and efficacy of salpingectomy as a preventive strategy for ovarian cancer warrant to conduct in the future.

Bilateral salpingectomy to reduce the risk of ovarian/fallopian/peritoneal cancer in women at average risk: a position statement of the Korean Society of Obstetrics and Gynecology (KSOG)

“…Prophylactic salpingectomy at the time of hysterectomy for benign disease was applied to women in 70–80% of institutions accredited by an academic society and in 50–65% of institutions not accredited by an academic society in Japan [ 54 ]. In China, the rate of bilateral salpingectomy increased threefold (from 22% to 60%) from 2007 to 2017 [ 55 ]. Corresponding data from Korea are unavailable.…”

Occult Tubal Carcinoma Found at Opportunistic Salpingectomy: Incidence and Implications

“…In a case-controlled study by Chen et al, patients diagnosed with epithelial ovarian cancer or primary peritoneal cancer who had previously undergone benign gynecologic procedures were compared to casematched controls. 4 The incidence of cancer was significantly decreased in patients who underwent salpingectomy, compared to those whose fallopian tubes remained in situ ( p < 0.05) 4 Various studies have demonstrated feasibility, safety, and financial benefit of performing an OBS during a vaginal surgery. In 2 prospective studies of women undergoing vaginal hysterectomy, primarily for POP, a vaginal salpingectomy was performed successfully in 73.9% and 81% of cases, respectively 5,6 Risk factors for failure included older age, menopausal status, and elevated body mass index, as well as prior adnexal surgery and uterine fibroids.…”

Molecular genetic testing in ovarian cancer

“…В качестве превентивной тактики необходимо минимизировать влияние факторов-модификаторов пенетрантности мутаций, таких как использование внутриматочных девайсов, заместительная гормональная терапия, курение, ожирение. Профилактическая билатеральная овариоэктомия ассоциирована со значительным снижением риска развития и показателей смертности от РЯ у носительниц мутаций в генах ВRСА1, 2 [49,50]. Однако доказательная база эффективности данного метода хирургической профилактики при обнаружении мутаций в других генах-кандидатах на сегодня отсутствует.…”