You may be aware that we are now routinely offering patients bilateral salpingectomies at the time of hysterectomy. Although this was not recommended in the past, because of worries in hastening the onset of the menopause recent studies have suggested that this should be offered to all patients undergoing routine pelvic surgery.
Much like studies that suggest that endometriotic cysts in the ovaries do not start in the ovaries themselves but are the result of implantation of endometriotic cells on the surface of the ovaries, newer studies have suggested the Ca Ovary does not commence in the ovaries but are actually tubal cells that are implanting on the surface of the ovary.
The majority of epithelial ovarian cancers and serous carcinomas which very closely resemble that of the fallopian tubes. The studies implicate the tubes (and the endometrium) as the origin of the Ovarian Cancers.
You can refer to a more detailed article on the subject in the January 2015 issue of Obstetrics & Gynecology here.
There has also been research that has shown the protective effect of tubal ligation against endometrioid and clear cell carcinomas, suggesting these tumors may arise from retrograde menses.
They determined that removal of the tubes with preservation of the ovaries, would be a healthier option for prevention of Ovarian Cancer, than oophorectomy and bilateral salpingo-oophorectomy as removal of the ovaries, will definitely cause the onset of premature menopause and increase risks for for cardiovascular disease, osteoporosis, and cognitive impairment and were also associated with a raised risk for all-cause and cancer specific mortality in the Nurses’ Health Study.
It is now recommended that this option be offered to anyone undergoing surgery for other reasons, including hysterectomies and that the reasons and risks are clearly outlined to the patients.
At the Womens Health Centre, I have been offering salpingectomies to my patients for almost a year. There has been an almost 80% uptake, with patients have opting to have their tubes removed at the time of surgery regardless of the risks of premature menopause..
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.