Prophylactic salpingectomy

Prophylactic salpingectomy is a preventative surgical technique performed on patients who are at higher risk of having ovarian cancer, such as individuals who may have the BRCA1 or BRCA2 gene. Originally salpingectomy was used in cases of ectopic pregnancies. As a preventative surgery however, it involves the removal of the fallopian tubes. By not removing the ovaries this procedure is advantageous to individuals who are still of child bearing age. It also means risks such as cardiovascular disease and osteoporosis which are associated with removal of the ovaries are reduced.

In 2013 in America alone there were 22,000 cases of ovarian cancer diagnosed and reported. Of these 10% were due to an inherited disorder. It is also the fifth most common cancer related cause of death in women. The BRCA1 and BRCA2 genes are the most common inherited genetic mutations which lead to ovarian cancer. As such a preventative surgery such a prophylactic salpingectomy is thought to decrease this risk of getting cancer. Recent research has shown that ovarian cancer may not originate in the ovaries themselves but start in the fallopian tubes. It is therefore thought that in women who are of child bearing age the more common salpingo-oophorectomy may not be the correct surgery of choice.

A bilateral prophylactic salpingectomy with ovarian conservation was proposed as a “middle-ground" method of primary prevention, with the benefit of removing potential tissue of origin without the risks of surgical menopause. This method has been proposed for clinical trials in high-risk patients, but results are not currently available.

Potential indications for Prophylactic Salpingectomy:

In 2013, the SGO released a clinical practice statement recommending that a bilateral salpingectomy should be considered “at the time of abdominal or pelvic surgery, hysterectomy, or in lieu of tubal ligation”. The American College of Obstetricians and Gynecologists (ACOG) recommended that the procedure should be considered for population-risk patients: those without increased risk based on personal or family history, but they were clear that the approach to pelvic surgery, hysterectomy, or sterilization should not change simply to increase the chances of completing bilateral salpingectomy. The proposed plan of the British Columbia Ovarian Cancer Research Group program, involved performing opportunistic salpingectomy with benign hysterectomy or in lieu of bilateral tubal ligation for permanent contraception. It is suggested that this approach would yield a 20-40 percent population risk reduction for ovarian cancer over the next 20 years. However, overall there is insufficient evidence to support this practice as a safe alternative and risk-reducing bilateral salpingo-oophorectomy remains the recommended standard of care for high-risk women.

...
Wikipedia