Does prophylactic bilateral salpingectomy during pelviscopic hysterectomy increase perioperative morbidity?

Purpose of investigation: To compare the safety of additional salpingectomies in patients undergoing laparoscopic hysterectomies for benign indication. Materials and Methods: The study was conducted in the Ortenau Klinikum Offenburg (Baden-Wurttemberg, Germany). Classical laparoscopic hysterectomies were performed between 2010 and 2011 and a prophylactic salpingectomy was added thereafter. The authors analysed the postoperative complications until 2013 according to the Clavien-Dindo scale in performing a logistic regression model adjusted on potential confounders. They also analysed other surgery outcomes such as operative time, duration of the hospital stay, and the blood loss during the surgery. Results: Over 301 patients were retrieved from the records. Postoperative complication rates were not different between the two groups (13.8% versus 14.2 % patients, OR = 0.93 [0.47 – 1.84], p = 0.84). Other outcomes were also not different. Conclusion: Prophylactic salpingectomy performed during a laparoscopic hysterectomy for benign conditions seems to be safe and recommended. Prospective studies especially with respect to the magnitude of the prophylactic effect are needed.

Prophylactic salpingectomy; Ovarian cancer prevention.

[1] Buys S.S., Partridge E., Black A., Johnson C.C., Lamerato L., Isaacs C., et al.: “Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial”. JAMA, 2011, 305, 2295.

[2] U.S. Preventive Services Task Force: “Screening for Ovarian Cancer: Brief Evidence Update” (2004). Available at: http://www.uspreventiveservicestaskforce.org/3rduspstf/ovariancan/ovcanup.htm

[3] Prescrire Rédaction: “Dépistage des cancers de l’ovaire: délétère”. Rev. Prescrire, 2012, 32, 129. [Article in French]

[4] Parker W.H., Shoupe D., Broder M.S., Liu Z., Farquhar C., Berek J.S.: “Elective oophorectomy in the gynecological patient: when is it desirable?” Curr. Opin. Obstet. Gynecol., 2007, 19, 350.

[5] Berek J.S., Chalas E., Edelson M., Moore D.H., Burke W.M., Cliby W.A., et al.: “Prophylactic and risk-reducing bilateral salpingooophorectomy: recommendations based on risk of ovarian cancer”. Obstet. Gynecol., 2010, 116, 733.

[6] Piek J.M., van Diest P.J., Zweemer R.P., Jansen J.W., Poort-Keesom R.J., Menko F.H., et al.: “Dysplastic changes in prophylactically removed Fallopian tubes of women predisposed to developing ovarian cancer”. J. Pathol., 2001, 195, 451.

[7] Callahan M.J., Crum C.P., Medeiros F., Kindelberger D.W., Elvin J.A., Garber J.E., et al.: “Primary fallopian tube malignancies in BRCA-positive women undergoing surgery for ovarian cancer risk reduction”. J. Clin. Oncol., 2007, 25, 3985.

[8] Carlson J.W., Miron A., Jarboe E.A., Parast M.M., Hirsch M.S., Lee Y., et al.: “Serous Tubal Intraepithelial Carcinoma: Its Potential Role in Primary Peritoneal Serous Carcinoma and Serous Cancer Prevention”. J. Clin. Oncol., 2008, 26, 4160.

[9] Kindelberger D.W., Lee Y., Miron A., Hirsch M.S., Feltmate C., Medeiros F., et al.: “Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: Evidence for a causal relationship”. Am. J. Surg. Pathol., 2007, 31, 161.

[10] Przybycin C.G., Kurman R.J., Ronnett B.M., Shih I.M., Vang R.: “Are all pelvic (nonuterine) serous carcinomas of tubal origin?” Am. J. Surg. Pathol., 2010, 34, 1407.

[11] Reade C.J., Riva J.J., Busse J.W., Goldsmith C.H., Elit L.: “Risks and benefits of screening asymptomatic women for ovarian cancer: A systematic review and meta-analysis”. Gynecol Oncol., 2013, 130, 674.

[12] Staebler A.: “Vorläuferläsionen der Ovarialkarzinome”. Pathologe, 2011, 32, 265. [Article in German]

[13] Tone A.A., Salvador S., Finlayson S.J., Tinker A.V., Kwon J.S., Lee C.H., et al.: “The role of the fallopian tube in ovarian cancer”. Clin. Adv. Hematol. Oncol., 2012, 10, 296.

[14] Vang R., Shih I.M., Kurman R.J.: “Fallopian tube precursors of ovarian low- and high-grade serous neoplasms”. Histopathology, 2013, 62, 44.

[15] Kurman R.J., Shih I.M.: “Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer--shifting the paradigm”. Hum. Pathol., 2011, 42, 918.

[16] Kuhn E., Kurman R.J., Vang R., Sehdev A.S., Han G., Soslow R., et al.: “TP53 mutations in serous tubal intraepithelial carcinoma and concurrent pelvic high-grade serous carcinoma--evidence supporting the clonal relationship of the two lesions”. J. Pathol., 2012, 226, 421.

[17] Mehra K., Mehrad M., Ning G., Drapkin R., McKeon F.D., Xian W., et al.: “STICS, SCOUTs and p53 signatures; a new language for pelvic serous carcinogenesis”. Front. Biosci. (Elite Ed.), 2011, 3, 625.

[18] Salvador S., Gilks B., Köbel M., Huntsman D., Rosen B., Miller D.: “The fallopian tube: primary site of most pelvic high-grade serous carcinomas”. Int. J. Gynecol. Cancer, 2009, 19, 58.

[19] Chêne G., Penault-Llorca F., Raoelfils I., Bignon Y.J., Ray-Coquard I., Seffert P., et al.: “Ovarian carcinogenesis: recent and past hypotheses”. Gynecol. Obstet. Fertil., 2011, 39, 216. [Article in French]

[20] Crum C.P., Drapkin R., Miron A., Ince T.A., Muto M., Kindelberger D.W., et al.: “The distal fallopian tube: a new model for pelvic serous carcinogenesis”. Curr. Opin. Obstet. Gynecol., 2007, 19, 3.

[21] Reade C.J., McVey R.M., Tone A.A., Finlayson S.J., McAlpine J.N., Fung-Kee-Fung M., et al.: “The fallopian tube as the origin of high grade serous ovarian cancer: review of a paradigm shift”. J. Obstet. Gynaecol. Can., 2014, 36, 133.

[22] Greene M.H., Mai P.L., Schwartz P.E.: “Does bilateral salpingectomy with ovarian retention warrant consideration as a temporary bridge to risk-reducing bilateral oophorectomy in BRCA1/2 mutation carriers?” Am. J. Obstet. Gynecol., 2011, 204, 19.e1.

[23] Kamran M.W., Vaughan D., Crosby D., Wahab N.A., Saadeh F.A., Gleeson N.: “Opportunistic and interventional salpingectomy in women at risk: a strategy for preventing pelvic serous cancer (PSC)”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2013, 170, 251.

[24] Gilks C.B., Miller D.: “Opportunistic salpingectomy for women at low risk for development of ovarian carcinoma: the time has come”. Gynecol. Oncol., 2013, 129, 443.

[25] Foulkes W.D.: “Preventing ovarian cancer by salpingectomy”. Curr. Oncol., 2013, 20, 139.

[26] Dwyer P.L.: “Ovarian cancer and the pelvic floor surgeon: the case for prophylactic bilateral salpingectomy during POP surgery”. Int. Urogynecol. J., 2012, 23, 655.

[27] Westgren M.: “Prevention of ovarian cancer--let’s do something”. Acta Obstet. Gynecol. Scand., 2012, 91, 1009.

[28] Anderson C.K., Wallace S., Guiahi M., Sheeder J., Behbakht K., Spillman M.A.: “Risk-reducing salpingectomy as preventative strategy for pelvic serous cancer”. Int. J. Gynecol. Cancer, 2013, 23, 417.

[29] Narod S.A.: “Salpingectomy to prevent ovarian cancer”. Curr. Oncol., 2013, 20, 145.

[30] Dietl J., Wischhusen J.: “The forgotten fallopian tube”. Nat. Rev.Cancer, 2011, 11, 227.

[31] Jaton C., Meyer-Hamme U., Petignat P., Kayser B., Irion O., Boulvain M.: “What’s new in gynecology and obstetrics”. Rev. Med. Suisse, 2012, 8, 92. [Article in French]

[32] Dietl J., Wischhusen J., Häusler S.F.M.: “The post-reproductive Fallopian tube: better removed?” Hum. Reprod., 2011, 26, 2918.

[33] Gill S.E., Mills B.B.: “Physician opinions regarding elective bilateral salpingectomy with hysterectomy and for sterilization”. J. Minim. Invasive Gynecol., 2013, 20, 517.

[34] Dindo D., Demartines N., Clavien P.A.: “Classification of Surgical Complications”. Ann. Surg., 2004, 240, 205.

[35] R Development Core Team: “R: A language and environment for statistical computing”. Available at: http://www.R-project.org

[36] Minig L., Chuang L., Patrono M.G., Cárdenas-Rebollo J.M., García- Donas J.: “Surgical outcomes and complications of prophylactic salpingectomy at the time of benign hysterectomy in premenopausal women”. J. Minim. Invasive Gynecol., 2015, 22, 653.

[37] Morelli M., Venturella R., Mocciaro R., Di Cello A., Rania E., LicoD., et al.: “Prophylactic salpingectomy in premenopaus al low-risk women for ovarian cancer: primum non nocere”. Gynecol. Oncol., 2013, 129, 448.

[38] McAlpine J.N., Hanley G.E., Woo M.M.M., Tone A.A., Rozenberg N., Swenerton K.D., et al.: “Opportunistic salpingectomy: uptake, risks, and complications of a regional initiative for ovarian cancer prevention”. Am. J. Obstet. Gynecol., 2014, 210, 471.e1.

[39] Vorwergk J., Radosa M.P., Nicolaus K., Baus N., Jimenez Cruz J., Rengsberger M., et al.: “Prophylactic bilateral salpingectomy (PBS) to reduce ovarian cancer risk incorporated in standard premenopausal hysterectomy: complications and re-operation rate”. J. Cancer Res. Clin. Oncol., 2014, 140, 859.

[40] Ghezzi F., Cromi A., Siesto G., Bergamini V., Zefiro F., Bolis P.: “Infectious morbidity after total laparoscopic hysterectomy: does concomitant salpingectomy make a difference?” BJOG, 2009, 116, 589.

[41] Berlit S., Tuschy B., Kehl S., Brade J., Sütterlin M., Hornemann A.: “Laparoscopic supracervical hysterectomy with concomitant bilateral salpingectomy--why not?” Anticancer Res., 2013, 33, 2771.

[42] Findley A.D., Siedhoff M.T., Hobbs K.A., Steege J.F., Carey E.T., McCall C.A., et al.: “Short-term effects of salpingectomy during laparoscopic hysterectomy on ovarian reserve: a pilot randomized controlled trial”. Fertil. Steril., 2013, 100, 1704

[43] Sezik M., Ozkaya O., Demir F., Sezik H.T., Kaya H.: “Total salpingectomy during abdominal hysterectomy: effects on ovarian reserve and ovarian stromal blood flow”. J. Obstet. Gynaecol. Res., 2007, 33, 863.