Opportunistic prophylactic salpingectomy: A literature review

Ovarian cancer (OC) is one of the most heterogeneous gynecological cancers, known as the silent killer. This thesis aims to summarize published evidence of the epidemiology of OC, risk and protective factors, the etiology and biology of the disease, to underline the lack of effective screening methods and finally focus on opportunistic prophylactic salpingectomy (OS) as the novel risk-reducing strategy. OC is the fourth most frequent gynecologic cancer and the third cause of gynecologic cancer death. A woman’s lifetime risk of developing OC is 1 in 75 and her chance of dying of the disease is 1 in 100. Well-established risk factors for ovarian cancer include genetic factors, increasing age, endometriosis and nulliparity while oral contraceptives, higher parity, lactation, and tubal ligation have been some of the factors associated with reduced risk. The concept that high grade serous ovarian carcinoma (HGSC), the most common and aggressive type of OC, arises from surface epithelial cells has changed revolutionary since 2001. Mounting evidence supported that the distal fimbriated part of the fallopian tubes was the culprit, with the recognition of serous tubal intraepithelial lesion (STIC) as the precursor lesion. Due to the absence of effective screening tools, OS was proposed as a preventive risk-reducing surgery in the general population and as a possible alternative two-step procedure (prophylactic salpingectomy with delayed oophorectomy) for high-risk population. OS is defined as additional complete removal of the extramural part of the fallopian tubes bilaterally, while preserving the ovaries with their infundibulopelvic blood supply, during a benign pelvic (benign gynecological or sterilization) or other abdominal surgery. Several studies have supported the positive effect of OS on the ovarian cancer risk, with rates between 42-64%. OS appeared to be feasible by any surgical route (open, laparoscopic, robotic, or vaginal) and safe as far as the short term (peri and postoperative) complications is concerned. Moreover, it seemed to lack the detrimental impact of oophorectomy on ovarian reserve and on the onset of menopause. Different theoretical models concluded that OS is cost-effective as an OC prevention strategy for the general population. Furthermore, evidence suggested greater OC risk reduction with OS in comparison to tubal ligation for sterilization The implementation of OS in general population is increasing, in accordance with the current recommendations of numerous gynecological societies. In the high-risk population, it should not currently be recommended outside of clinical trials. OS holds promise as a risk-reducing strategy for OC. It should be discussed with all gynecologic patients undergoing a pelvic surgery for benign indications or sterilization. Numerous studies are ongoing to provide more data needed to evaluate the exact risk-reducing effect of OS and its long-term implications.