Bilateral Opportunistic Salpingectomy to Reduce the Incidence of Ovarian Cancer

Key Message

What Is the Issue?

• Ovarian cancer is a common gynecological malignancy, with the highest mortality rate. Presently, there are no screening tools that can detect ovarian cancer at an early stage. As a result, there is a need for other preventive options.
• Recent research suggests that the most common type of ovarian malignancy may originate in parts of the fallopian tube rather than the ovary itself.
• Bilateral opportunistic salpingectomy involves removal of both fallopian tubes while a person is undergoing abdominal surgery for another indication (e.g., a partial hysterectomy, Caesarean section), while leaving the ovaries intact. This procedure may be a possible prevention strategy for ovarian cancer, and it is therefore important to understand its potential harms and benefits.

What Did We Do?

• To inform decisions about bilateral opportunistic salpingectomy to reduce the incidence of ovarian cancer in people at general population risk of the disease, we sought to identify and summarize literature examining the safety and efficacy of bilateral opportunistic salpingectomy compared with other abdominal surgeries without bilateral opportunistic salpingectomy. We also aimed to identify and summarize information on the cost-effectiveness of, and recommendations regarding best practices for, bilateral opportunistic salpingectomy in this population.
• We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since January 1, 2019.

What Did We Find?

• Outcomes related to the benefits and harms for bilateral opportunistic salpingectomy are mixed, compared with tubal ligation. People who undergo bilateral opportunistic salpingectomy may experience longer surgical times, fill more prescriptions for pain medication, but experience fewer perioperative complications and be less likely to have postoperative ultrasounds and laboratory visits (1 retrospective cohort study). There may not be any statistically significant differences in endocrine function and other postoperative adverse events between the 2 groups (1 systematic review [SR], 1 retrospective cohort study).
• Outcomes related to the benefits and harms for hysterectomy with bilateral opportunistic salpingectomy are mixed, compared with hysterectomy alone. People who undergo bilateral opportunistic salpingectomy may experience longer hospital stays and greater risk of menopausal symptoms 1 year after surgery, but less perioperative bleeding (2 retrospective cohort studies). There may not be any statistically significant differences in blood transfusions, duration of surgery, or other postoperative outcomes (1 retrospective cohort study). There may be no difference in menopause onset 4 weeks to 6 months after surgery, but a shorter time to menopause in the bilateral opportunistic salpingectomy group when followed up for 5 years (1 SR, 1 retrospective cohort study).
• None of the included studies reported on the incidence of ovarian cancer.
• We did not find any evidence-based guidelines or economic evaluations regarding the use of bilateral opportunistic salpingectomy to reduce the incidence of ovarian cancer.

What Does It Mean?

• The available evidence suggests that the benefits and harms of bilateral opportunistic salpingectomy vary, compared with both tubal ligation and hysterectomy alone. To inform future clinical practice, decision-makers may want to consider these potential risks and benefits.
• Findings from the included SRs were rated as low to very low certainty and should be interpreted accordingly. Additional clinical studies would help strengthen the evidence base and provide a better understanding of the benefits and harms of bilateral opportunistic salpingectomy for people at general population risk of ovarian cancer.
• Longitudinal studies that examine the incidence of ovarian cancer in this population would help illustrate the clinical effectiveness of this procedure.