Opportunistic salpingectomy at benign gynecological surgery for reducing ovarian cancer risk: a 10-year single centre experience from China and a literature review

Abstract

Current evidences indicate that the fallopian tube plays a major role in the pathogenesis of epithelial ovarian cancer (EOC). Salpingectomy represents a novel and potentially effective risk-reducing option. In this study, there were 1822 patients diagnosed and treated for EOC or primary peritoneal cancer (PPC) at Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital from January 1, 2007 to April 30, 2017. Among them, 198 patients with a history of gynecological surgery because of benign diseases were enrolled to analyze further. Using 1:2 case-control study, we found that the incidence of EOC was significantly decreased in the population with salpingectomy, compared to women with fallopian tube reserved (P<0.05). At the same period, there were 4339 patients receiving opportunistic salpingectomy in our centre because of benign gynecological diseases. The results showed the rate of bilateral salpingectomy was annually increased from 2007 to 2017 (22.02% to 60.22%), which showed approximately threefold increase in a decade. In general, factors affecting the rate of salpingectomy included age, child number, menopause or not, marital status, educational status, income status, and with or without family history of tumor. Therefore, based on ten years experiences from our centre, it is recommended that physician should discuss with appropriate patients to perform opportunistic bilateral salpingectomy at the time of receiving benign gynecological surgery for preventing ovarian cancer. Moreover, the prospective, large scale and multi-centre studies to evaluate the safety and efficacy of salpingectomy as a preventive strategy for ovarian cancer warrant to conduct in the future.

Keywords: fallopian tubes; ovarian cancer; risk reduction; salpingectomy.

Figure 1

There were 198 patients with a history of gynecological surgery because of benign diseases in our centre. Among them, 65 cases had the history of hysterectomy (33%); 48 cases had the history of receiving unilateral salpingoophorectomy (USO) therapy (24%); 36 cases had history of receiving hysterectomy and USO (18%); 24 cases had operation history of receiving hysterectomy and bilateral salpingectomy (12%); 14 cases had history of bilateral salpingoophorectomy (BSO) therapy (7%); 11 cases had history of receiving hysterectomy and BSO (6%).

Figure 2

The overall rate of bilateral salpingectomy was gradually increased in our centre from 2007 to 2017 (from 22.02% to 60.22%), which showed approximately threefold increase in a decade.