Should specialists perform bilateral salpingectomies routinely?

You would have noticed recently a trend for gynaecologists to increasingly offer our patients a bilateral salpingectomy at the time of hysterectomy. In the past this was frowned upon as it was thought that removal of the tubes may compromise ovarian blood supply and result in an earlier menopause. Recent studies however have suggested that removal of the fallopian tubes may help prevent ovarian cancer. You can refer to a more detailed article on the subject in the January 2015 issue of Obstetrics & Gynecology here.

This studies suggest that epithelial ovarian cancers specifically serous, endometriod and clear cell cancers, rather than arising from elements of surface of the ovaries as previously thought, derives from elements of the fallopian tube and endometrium.

The survival rate for ovarian cancer has not improved much during the last 50 years. About 75% of ovarian cancers and 90% of deaths from ovarian cancer result from epithelial ovarian cancer, they write. Research has also pointed to a protective effect of tubal ligation against endometrioid and clear cell carcinomas, suggesting these tumors may arise from retrograde menses.
In the article the committee suggest “Salpingectomy at the time of hysterectomy or as a means of tubal sterilization appears to be safe, without an increase in complications…compared with hysterectomy alone or tubal ligation,”
“Counselling women who are undergoing routine pelvic surgery about the risks and benefits of salpingectomy should include an informed consent discussion about the role of oophorectomy and bilateral salpingo-oophorectomy.”
This includes women who do not have an elevated genetic risk for ovarian cancer but who are having routine pelvic surgery for benign disease.
Among gynaecologic cancers, ovarian cancer carries the highest mortality rate; it ranks as the fifth leading cause of death from cancer in women, the authors note.

The committee made the following recommendations:

  • In women at population risk for ovarian cancer, surgeons should discuss the potential benefits of salpingectomy.
  • In women considering laparoscopic sterilization, physicians can discuss the fact that bilateral salpingectomy provides effective contraception, while pointing out that this procedure eliminates the option of tubal reversal.
  • Prophylactic salpingectomy may prevent ovarian cancer in some patients.
  • More randomized controlled trials are needed to support the use of salpingectomy in reducing ovarian cancer.

Based on the studies above the committee concluded that salpingectomy while leaving the ovaries intact may be better for cancer prevention than oophorectomy and bilateral salpingo-oophorectomy as oophorectomy has been shown to cause early menopause and increased risk for cardiovascular disease, osteoporosis, and cognitive impairment and were also linked to increased risk for all-cause and cancer specific mortality in the Nurses’ Health Study.

They have suggested that this now be discussed with any patient who has completed their family who are undergoing surgery for other reasons, and that this should be offered to all women undergoing hysterectomy with the reasons clearly outlined and the patient making the choice.

Although I have only been offering this in my practice over the last year, the current trend is that almost 80% of patients have opted to have their tubes removed at the time of surgery despite the chance that this might result in an earlier menopause..

Wikipedia information on Salpingectomy


Categories : Medical | Author: Glen Hunter | Comments: no responses | Date: January 29, 2015 | Tags : gynaecologist hamilton salpingectomies

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