Opportunistic salpingectomy: Is surgical completeness achieved? Insights from the QOS study

Patients scheduled for gynaecological surgery involving unilateral or bilateral adnexectomy were prospectively enrolled in the Quality of Opportunistic Salpingectomy (QOS) study at two hospitals in Flanders. During the procedure, adnexectomy was performed in two steps: first salpingectomy, followed by oophorectomy. Pathologists examined the ovarian surface both macroscopically and microscopically to determine the presence of residual fimbrial tissue. For pathological analysis, the Sectioning and Extensively Examining the Fimbria (SEE-FIM) protocol or a modified SEE-FIM protocol was used. The predefined sample size was 192 adnexa. Patient enrolment occurred between January 2023 and April 2025.

A total of 201 adnexa from 115 patients were analysed. Macroscopic fimbrial tissue on the ovarian cortex was suspected in six cases (2.7%), of which four were microscopically confirmed. Overall, residual microscopic fimbrial tissue was identified in 15 adnexa (7.4%) from 14 patients (12.2%). In one patient, both fallopian tubes were incompletely resected. No serous tubal intraepithelial carcinoma (STIC) lesions were detected.

Opportunistic salpingectomy was surgically complete in almost nine out of ten patients. Residual fimbrial tissue could not be predicted by clinical or surgical factors, underscoring the importance of a meticulous surgical technique and standardized pathological assessment. The clinical impact of remnant fimbrial tissue on ovarian cancer risk reduction remains uncertain, particularly in the context of risk-reducing salpingectomy with delayed oophorectomy.