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 pathogenic variants of the BRCA1 or BRCA2 gene.

[1] [3] 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.

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.

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.

2) Another study looking at BRCA-positive women who are reluctant to undergo prophylactic surgery – this refusal increase risk of developing serious pelvic carcinoma.

[8] A Nationwide study[9] found statistically lower risk of ovarian cancer among women with previous salpingectomy when compared to the unexposed population.

High-Grade Serous Carcinoma (HGSC) is usually driven by BRCA gene mutations – it was hypothesised that a decrease risk of ovarian cancer observed among women with salpingectomy reflects the effect of the removed tubal epithelium (fallopian tube).

This was the first population based study describing the association between removing fallopian tubes and decreasing risk of ovarian cancer.

This is a reassuring and highly interesting result as both of these complications were voiced as surgical concerns at the time prophylactic salpingectomy was first proposed.

In patients with hydrosalpinx, it is highly beneficial to have prophylactic salpingectomy before conceiving due to potential difficulties in achieving pregnancy.

[14] Medical experience with bilateral salpingectomy over the past 5–10 years gave us confidence that the surgical removal of the tubes would not result in the negative consequences of oophorectomy such as impaired sexuality and osteoporosis due to reduced testosterone levels.

However, only 60-70% of BRCA mutation carriers undergo BSO currently, which is related to the generation of premature surgical menopause in the patient and the associated risks of oestrogen deficiency, urogenital atrophy, osteoporosis, and cardiovascular disease.