Ovarian Function in Patients Who Underwent Opportunistic Bilateral Salpingectomy during Hysterectomy

Abstract

Objective(s):To provide additional data and to inform all women at average risk of ovarina cancer, undergoing a benign gynecological laparoscopic procedure about the Pro's and the Con's of opportunistic bilateral salpingectomy (OBS). Mechanism: Risk reducing salpingo-oophorectomy to prevent epithelial ovarian cancer (EOC) is associated with decreased quality of life and increased overall mortality. OBS has emerged as a primary prevention of ovarian cancer through a paradigm shift in which fallopian tubes are often the cause of ovarian cancer rather than the ovaries themselves. Findings in Brief: Causal relationship of salpingectomy and reduced risk of ovarian cancer has not been proven yet. There are several population-based studies that showed bilateral salpingectomy reduced risk of EOC by 42-67%, but there also is a study that suggest increased risk of ovarian cancer after salpingectomy. As for risk of surgical complications, several cohort studies have demonstrated that there was no increase in rates of hospital readmission, blood transfusion, day of hospital stay. However, recent meta-analysis stated that there were insufficient data to assess any difference in both intraoperative and postoperative complication rates. The procedure of salpingectomy can disrupt blood supply to the ovary. Data of reproductive outcome after assisted reproductive technologies such as in vitro fertilization and embryo transfer (IVF-ET) are conflicting. Some studies suggest that salpingectomy did not compromise the outcome of IVF-ET, but other studies found that salpingectomy may lead to decreased ovarian reserve after salpingectomy. For patients who do not wish fertility, data on the effect of OBS during hysterectomy suggest that changes in serum ovarian reserve markers were not different between OBS group and control group. Conclusions: Bilateral salpingectomy should be considered at the time of abdominal or pelvic for women at average risk of ovarian cancer. However, physicians should discuss the protective benefit of bilateral salpingectomy against ovarian cancer and controversial data on ovarian reserve.