Removing Fallopian Tubes During Hysterectomy May Curb Ovarian Cancer Risk

By Marilynn Larkin

February 22, 2022

NEW YORK (Reuters Health) - Removal of the fallopian tubes during hysterectomy or instead of tubal ligation, a procedure known as opportunistic salpingectomy (OS), was associated with fewer serous and epithelial ovarian cancers than expected in a retrospective analysis.

"We recommend that clinicians discuss OS with their patients and tell them about the safety and preliminary effectiveness evidence for this procedure," Dr. Gillian Hanley of Vancouver General Hospital Research Pavilion told Reuters Health by email. "We still have no effective screening method for ovarian cancer; thus, prevention is our best approach, and these data suggest that OS is a safe and effective prevention strategy."

"Of course, patients can choose not to undergo OS, but the only contraindications are the presence of a genetic mutation that would increase risk for ovarian cancer (as we recommend that fallopian tubes AND ovaries be removed in people at genetically increased risk) and wanting to have a future pregnancy," she noted. "We also do not recommend that surgeons alter their surgical approach to access the fallopian tubes. This is most relevant for people undergoing vaginal hysterectomy, where it is sometimes difficult to access both tubes."

Dr. Hanley and colleagues' analysis, published in JAMA Network Open, included close to 25,000 individuals who underwent OS (mean age, 40.2; median follow-up, 3.2 years) and more than 32,000 (controls) who underwent hysterectomy alone or tubal ligation (mean age, 38.2; median follow-up, 7.3 years).

No serous ovarian cancers and five or fewer epithelial ovarian cancers occurred in the OS group, whereas the age-adjusted expected numbers were 5.27 and 8.68, respectively.

By contrast, the age-adjusted expected versus observed numbers of breast cancers (22.1 vs. 23, respectively) and colorectal cancers (9.35 vs. 8) were not significantly different.

The authors conclude, "These findings suggest that OS is associated with reduced ovarian cancer risk."

Dr. Hanley said, "As the numbers of cancers in our study were quite small by the end of follow-up, we will continue to follow these people to ensure these preliminary findings hold with more follow-up time. We are also starting a project expanding OS to offer it at the time of colorectal surgery, and we are pursuing other abdominal surgeries where the fallopian tubes are accessible to increase the opportunities to prevent ovarian cancer."

"We plan to study the high-grade serous ovarian cancers that do arise in people who have had OS (if some arise in the future) to closely to understand how they differ from cancers that arise in people with their fallopian tubes," she added. "There is still uncertainty about what proportion of high- grade serous ovarian cancers arise in the fallopian tube, and we hope to shed light on this while also better understanding molecular and other differences in these cancers."

Dr. Richard Leach, professor and chair of obstetrics gynecology and reproductive biology at Michigan State University in East Lansing, commented on the study in an email to Reuters Health. "There is evidence that removal of both fallopian tubes at the time of hysterectomy for benign conditions shows a 42%-65% reduction in the risk of the more common types of ovarian cancer," he said. "Most gynecological societies now recommend consideration of OS at the time of benign hysterectomy."

"In small retrospective studies, there is a significant increase in operative time, but not in other measures including length of hospital stay, readmissions, blood transfusions, or postoperative complications," he noted. "Larger prospective studies are needed to better assess."

SOURCE: https://bit.ly/33wYeRS JAMA Network Open, online February 9, 2022.

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