Review of Opportunistic Bilateral Salpingectomy during Gynaecological Surgery for Benign Disease: The evidence, controversies and future challenges — YRD
  1. Schedule
  2. Session 9: Free Communication Session D
  3. Review of Opportunistic Bilateral Salpingectomy during Gynaecological Surgery for Benign Disease: The evidence, controversies and future challenges

Review of Opportunistic Bilateral Salpingectomy during Gynaecological Surgery for Benign Disease: The evidence, controversies and future challenges (#D9)

Supuni Kapurubandara 1 2 3 , ApputhuraiA Anpalagan 1 3 , Alison Brand 1 4
  1. Western Clinical School , Sydney University, Sydney, NSW, Australia
  2. SWAPS, Sydney West Area Pelvic Surgery Unit, Sydney, Australia
  3. O&G, Westmead Hospital, Westmead, NSW, Australia
  4. Gyneoncology Department, Westmead Hospital, Westmead, NSW, Australia

Objective: To review the current evidence and controversies pertaining to opportunistic bilateral salpingectomy (OBS) and propose a guideline for clinical practice.

 

Background: Emerging epidemiological evidence highlight the fallopian tube to be the site of origin of pelvic serous cancers (PSC) including serous epithelial ovarian cancers.[1],2 This type of ovarian cancers have the highest mortality and represent the most common subtype with no effective screening test.2

Recognition of the malignant potential of the fallopian tubes has led to a shift in surgical practice, particularly in Canada and the United States of America, with increasing consideration of OBS at the time of hysterectomy for benign conditions and as an alternative for surgical sterilisation in the general population.3 Randomized controlled trials are needed to support the validity of this approach to reduce the incidence of ovarian cancer in a low risk population.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), Society of Gyneoncologic Oncology of Canada (GOC) and American College of Obstetricians and Gynecologists (ACOG) all support an individualized approach to counselling patients where the potential risks and benefits of OBS should be discussed.

 

A recent Australian survey revealed the sporadic adoption of OBS amongst RANZCOG fellows especially during abdominal and laparoscopic hysterectomies. An accepted standard of histological assessment of the fallopian tube specimen should be implemented in order to not miss any malignant or premalignant lesions. The clinical relevance of these lesions is unknown because of the uncertainty regarding managing such findings in an otherwise asymptomatic individual with no genetic risk factors.

 

While it is now clearer that OBS is being adopted both locally and internationally, the actual rates of uptake of OBS and, more importantly, its surgical and clinical outcomes within the Australian population is still uncertain. Currently, there is no separate Medicare item number for bilateral salpingectomy to enable easy identification of women choosing to undergo this additional procedure, as exists in other countries.3 Data regarding the number of women undergoing this procedure, linked with short and long term outcomes as could be provided in a national registry, would be beneficial in determining the true benefit, as well as any potential harms, of this procedure. 


 

  1. McCluggage WG. Morphological subtypes of Ovarian Carcinoma : a review with emphasis on new developments and pathogenesis. Pathology 2011;43: 420-32.
  2. Tone AA, Salvador S, Finlayson SJ, et al. The role of the fallopian tube in ovarian cancer. Clin Adv Hematol Oncol 2012;10:296–306.
  3. McAlpine JN, Hanley GE, Woo MM, Tone AA, Rozenberg N, Swenerton KD, et al. Opportunistic salpingectomy: uptake, risks, and complications of a regional initiative for ovarian cancer prevention. Ovarian Cancer Research Program of British Columbia. Am J Obstet Gynecol 2014;210:471.e1–e11