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Oncology

Salpingectomy for the Primary Prevention of Ovarian CancerA Systematic Review

To identify the key insights or developments described in this article

1 Credit CME

JAMA Surgery

Published Online: September 6, 2023

Review

Article Information and Disclosures

Ryan M. Kahn, MD¹;

Sushmita Gordhandas, MD¹;

Kendra Godwin, MLIS²;

Rebecca L. Stone, MD³;

Michael J. Worley Jr, MD⁴;

Karen H. Lu, MD⁵;

Kara C. Long Roche, MD^1,6

Author Affiliations

¹Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
²Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York
³Department of Obstetrics and Gynecology, Johns Hopkins Hospital, Baltimore, Maryland
⁴Department of Surgery, Dana-Farber Cancer Institute, Boston, Massachusetts
⁵Division of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
⁶Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York

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Key Points

Question What is the current landscape of performing bilateral salpingectomy for ovarian cancer prevention?

Findings This systematic review of 158 articles found that salpingectomy was associated with ovarian cancer risk reduction of approximately 80%; with widespread implementation, salpingectomy has the potential to reduce ovarian cancer mortality in the US by an estimated 15%. Raising awareness and developing effective implementation strategies are essential; prospective studies to demonstrate long-term survival outcomes and feasibility in nongynecologic surgical procedures are warranted.

Meaning This review suggests that bilateral salpingectomy for ovarian cancer prevention was safe and feasible and has the potential to be a cost-effective and cost-saving strategy across the population.

Abstract

Importance Most ovarian cancers originate in the fimbriated end of the fallopian tube. This has led to the hypothesis that surgical resection of the fallopian tubes at the time of gynecologic and nongynecologic surgical procedures—referred to as an opportunistic salpingectomy—may prevent the development of epithelial ovarian cancer for women at an average risk of developing the disease.

Objective To compile a comprehensive, state-of-the-science review examining the current landscape of performing bilateral salpingectomy for ovarian cancer prevention.

Evidence Review A systematic review of the literature was performed on March 4, 2022, to identify studies examining salpingectomy for ovarian cancer prevention. This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement. Four databases were selected: PubMed via the National Library of Medicine’s PubMed.gov, Embase via Elsevier’s Embase.com, Cochrane Central Register of Controlled Trials (CENTRAL) via Wiley’s Cochrane Library, and Northern Light Life Sciences Conference Abstracts via Ovid. A total of 20 gray literature sources, including 1 database, 2 registers, 1 repository, 1 index, 1 archive, 1 preprint server, 1 agency, and 12 organizations, were also searched.

Findings The initial search produced 1089 results; a total of 158 publications were included in the final review. Salpingectomy has been associated with ovarian cancer risk reduction of approximately 80%. Studies have demonstrated that salpingectomy was safe, cost-effective, and was not associated with an earlier age of menopause onset. With widespread implementation, salpingectomy has the potential to reduce ovarian cancer mortality in the US by an estimated 15%. Both physician and patient awareness regarding the adnexa as the origin for most ovarian cancers, as well as the existence of salpingectomy and its potential benefits in reducing ovarian cancer risk, has increased during the past decade. Raising awareness and developing effective implementation strategies are essential.

Conclusions and Relevance The results of this systematic review suggest that bilateral salpingectomy for ovarian cancer prevention was safe and feasible and has the potential to be a cost-effective and cost-saving strategy across the population. Prospective studies to demonstrate long-term survival outcomes and feasibility in nongynecologic surgical procedures are warranted.

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Article Information

Accepted for Publication: July 7, 2023.

Published Online: September 6, 2023. doi:10.1001/jamasurg.2023.4164

Corresponding Author: Kara C. Long Roche, MD, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (longrock@mskcc.org).

Author Contributions: Drs Kahn and Gordhandas had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Kahn and Gordhandas contributed equally.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Kahn, Gordhandas, Godwin, Stone, Worley, Long Roche.

Drafting of the manuscript: Kahn, Gordhandas, Godwin, Stone, Long Roche.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Long Roche.

Obtained funding: Long Roche.

Administrative, technical, or material support: Kahn, Gordhandas, Godwin, Worley, Lu, Long Roche.

Supervision: Kahn, Gordhandas, Godwin, Stone, Long Roche.

Conflict of Interest Disclosures: Dr Gordhandas reported receiving grants from the Foundation for Women’s Cancer outside the submitted work. Dr Stone reported receiving grants from Break Through Cancer Foundation during the conduct of the study; and serving as a consultant for and serving on the advisory board for AstraZeneca; serving on the advisory board for GSK; and receiving grants from Pacira Pharmaceuticals outside the submitted work. Dr Long Roche reported receiving travel support from Intuitive Surgical outside the submitted work. No other disclosures were reported.

Funding/Support: This research was funded in part by the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748.

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.