Prophylactic salpingectomy for prevention of ovarian cancer at the time of elective laparoscopic cholecystectomy

Abstract

Background Most serous ovarian cancers are now understood to originate in the fallopian tubes. Removing the tubes (salpingectomy) likely reduces the risk of developing high‐grade serous ovarian cancer. Numerous gynaecological societies now recommend prophylactic (or opportunistic) salpingectomy at the time of gynaecological surgery in appropriate women, and this is widely done. Salpingectomy at the time of non‐gynaecological surgery has not been explored and may present an opportunity for primary prevention of ovarian cancer. Methods This study investigated whether prophylactic salpingectomy with the intention of reducing the risk of developing ovarian cancer would be accepted and could be accomplished at the time of elective laparoscopic cholecystectomy. Women aged at least 45 years scheduled for elective laparoscopic cholecystectomy were recruited. They were counselled and offered prophylactic bilateral salpingectomy at the time of cholecystectomy. Outcome measures were rate of accomplishment of salpingectomy, time and procedural steps needed for salpingectomy, and complications. Results A total of 105 patients were included in the study. The rate of acceptance of salpingectomy was approximately 60 per cent. Salpingectomy was performed in 98 of 105 laparoscopic cholecystectomies (93·3 per cent) and not accomplished because of poor visibility or adhesions in seven (6·7 per cent). Median additional operating time was 13 (range 4–45) min. There were no complications attributable to salpingectomy. One patient presented with ovarian cancer 28 months after prophylactic salpingectomy; histological re‐evaluation of the tubes showed a previously undetected, focal serous tubal intraepithelial carcinoma. Conclusion Prophylactic salpingectomy can be done during elective laparoscopic cholecystectomy.

Association between pelvic inflammatory disease and subsequent salpingectomy on the risk for ovarian cancer

“…Concerns regarding the effect of opportunistic salpingectomy on subsequent ovarian function have not been substantiated by clinical data and the potential harm if any ought to be outweighed by the oncological benefits [18]. Indeed, the incidence of opportunistic salpingectomy in conjunction with hysterectomy appears to have increased substantially the past 10 years [19,20]. Recent studies indicate that women have a high acceptance for salpingectomy, also in combination with non-gynaecological procedures [20,21].…”

“…Indeed, the incidence of opportunistic salpingectomy in conjunction with hysterectomy appears to have increased substantially the past 10 years [19,20]. Recent studies indicate that women have a high acceptance for salpingectomy, also in combination with non-gynaecological procedures [20,21]. Several societies have issued statements supporting opportunistic salpingectomy at the time of hysterectomy on benign indications [22e24].…”

Incidence of pelvic high-grade serous carcinoma after isolated STIC diagnosis: A systematic review of the literature

“…RRSO was performed in 100 patients due to BRCA mutations or high-risk personal or family history. An opportunistic salping(o-oophor)ectomy was performed in the remaining twelve patients with an isolated STIC during surgery for benign reasons (ovarian cyst, cholecystectomy) ( 12 , 34 – 36 ). In some cases, additional procedures were performed, mostly hysterectomies.…”

Recommendations for diagnosing STIC: a systematic review and meta-analysis

“…Ki-67 is a non-specific proliferation marker. An increased proliferative activity is usually defined as an overall Ki-67 expression of more than 10% of cells, but alternative systems, whereby the maximum proliferative index within a part of the lesion is taken, have also been proposed [12,69] One of the challenges with Ki-67 however is the high risk of interlaboratory variability. Polley et al compared staining of 100 breast tissue samples in eight different labs and concluded that cut-off values for Ki-67 for clinical decision making cannot be automatically transferred between laboratories [73].…”

“…To also reduce ovarian cancer risk for low-risk women, an opportunistic salpingectomy can be considered under the appropriate circumstances. This means that the fallopian tubes are removed when a patient undergoes abdominal surgery for another benign indication [11,12]. Thirteen FIGO (International Federation of Obstetrics and Gynecology) member societies currently have statements regarding opportunistic salpingectomy, whereby a majority support considering this practice [13].…”