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. 2023 Nov 1;158(11):1204-1211.
doi: 10.1001/jamasurg.2023.4164.

Salpingectomy for the Primary Prevention of Ovarian Cancer: A Systematic Review

Ryan M Kahn  1 , Sushmita Gordhandas  1 , Kendra Godwin  2 , Rebecca L Stone  3 , Michael J Worley Jr  4 , Karen H Lu  5 , Kara C Long Roche  1   6
Affiliations

Salpingectomy for the Primary Prevention of Ovarian Cancer: A Systematic Review

Ryan M Kahn et al. JAMA Surg. .

Erratum in

Abstract

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.

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Conflict of interest statement

Dr Gordhandas reported receiving grants from the Foundation for Women’s Cancer outside the submitted work. Dr Stone reported receiving grants from Break Through Cancer Foundation during the conduct of the study; and serving as a consultant for and serving on the advisory board for AstraZeneca; serving on the advisory board for GSK; and receiving grants from Pacira Pharmaceuticals outside the submitted work. Dr Long Roche reported receiving travel support from Intuitive Surgical outside the submitted work.

Figures

Figure 1.
Figure 1.. Fallopian Tube Lifted With Graspers Exposing the Tubo-Ovarian Ligament and Mesosalpinx With Its Vasculature.
Scientific evidence supports the hypothesis that high-grade serous ovarian carcinoma arises from premalignant (serous tubal intraepithelial carcinoma) or malignant lesions originating in the fimbriated end of the fallopian tube instead of the ovary itself. The salpingectomy procedure requires transection of the tubo-ovarian ligament with excision of the mesosalpinx from the fimbriated end to the cornua of the uterus. Reproduced with permission from Gyyoung Oh, MA, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Figure 2.
Figure 2.
PRISMA Diagram of Articles Included
See this image and copyright information in PMC

References

    1. American Cancer Society. Cancer Facts & Figures 2022. American Cancer Society; 2022.
    1. National Cancer Institute; Surveillance, Epidemiology, and End Results Program. Cancer stat facts: ovarian cancer. Accessed February 24, 2022. https://seer.cancer.gov/statfacts/html/ovary.html
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