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Salpingectomy for the Primary Prevention of Ovarian Cancer: A Systematic Review
Ryan M Kahn1, Sushmita Gordhandas1, Kendra Godwin2
1Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Importance:
Most ovarian cancers originate in the fimbriated end of the fallopian tube. This has led to the hypothesis that surgical resection of the fallopian tubes at the time of gynecologic and nongynecologic surgical procedures-referred to as an opportunistic salpingectomy-may prevent the development of epithelial ovarian cancer for women at an average risk of developing the disease.
Objective:
To compile a comprehensive, state-of-the-science review examining the current landscape of performing bilateral salpingectomy for ovarian cancer prevention.
Evidence Review:
A systematic review of the literature was performed on March 4, 2022, to identify studies examining salpingectomy for ovarian cancer prevention. This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement. Four databases were selected: PubMed via the National Library of Medicine's PubMed.gov, Embase via Elsevier's Embase.com, Cochrane Central Register of Controlled Trials (CENTRAL) via Wiley's Cochrane Library, and Northern Light Life Sciences Conference Abstracts via Ovid. A total of 20 gray literature sources, including 1 database, 2 registers, 1 repository, 1 index, 1 archive, 1 preprint server, 1 agency, and 12 organizations, were also searched.
Findings:
The initial search produced 1089 results; a total of 158 publications were included in the final review. Salpingectomy has been associated with ovarian cancer risk reduction of approximately 80%. Studies have demonstrated that salpingectomy was safe, cost-effective, and was not associated with an earlier age of menopause onset. With widespread implementation, salpingectomy has the potential to reduce ovarian cancer mortality in the US by an estimated 15%. Both physician and patient awareness regarding the adnexa as the origin for most ovarian cancers, as well as the existence of salpingectomy and its potential benefits in reducing ovarian cancer risk, has increased during the past decade. Raising awareness and developing effective implementation strategies are essential.
Conclusions And Relevance:
The results of this systematic review suggest that bilateral salpingectomy for ovarian cancer prevention was safe and feasible and has the potential to be a cost-effective and cost-saving strategy across the population. Prospective studies to demonstrate long-term survival outcomes and feasibility in nongynecologic surgical procedures are warranted.
Insights
Opportunistic salpingectomy, the removal of fallopian tubes, significantly reduces ovarian cancer risk by approximately 80%. This safe and cost-effective procedure offers a promising strategy for preventing ovarian cancer and reducing mortality rates.
Area of Science:
- Gynecologic Oncology
- Preventive Medicine
- Surgical Innovation
Background:
- Epithelial ovarian cancer predominantly originates in the fallopian tubes.
- Opportunistic salpingectomy is proposed as a preventive measure for average-risk women.
Approach:
- A systematic review adhering to PRISMA 2020 guidelines was conducted.
- Searched four major databases (PubMed, Embase, CENTRAL, Northern Light) and 20 gray literature sources.
- Included 158 publications from an initial 1089 results.
Key Points:
- Salpingectomy is associated with an ~80% reduction in ovarian cancer risk.
- The procedure is safe, cost-effective, and does not hasten menopause.
- Widespread implementation could decrease US ovarian cancer mortality by ~15%.
Conclusions:
- Bilateral salpingectomy is a safe, feasible, and potentially cost-saving strategy for ovarian cancer prevention.
- Increased awareness of the adnexa's role in ovarian cancer and salpingectomy benefits is crucial.
- Further prospective studies are needed to confirm long-term survival and feasibility in non-gynecologic surgeries.
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