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Routine bilateral salpingectomy with hysterectomy gains acceptance


 

AT THE ACOG ANNUAL CLINICAL MEETING

NEW ORLEANS – Acceptance is growing for routine bilateral salpingectomy at the time of hysterectomy to reduce the risk of ovarian serous carcinoma, based on findings from a retrospective cohort study.

The bilateral salpingectomy rates at a single institution increased from 3% in 2010 to 73% in the first 6 months of 2012 – a year after the center began offering the procedure to all women undergoing hysterectomy with ovarian preservation, Dr. Susan K. Park reported at the annual meeting of the American College of Obstetricians and Gynecologists.

Dr. Susan Park

"Across the board, patient acceptance of undergoing salpingectomy was very high," she said. Patients were counseled at a preoperative appointment that salpingectomy may reduce the risk of posthysterectomy pelvic adnexal masses and serous carcinomas.

Only two women who were offered the procedure declined, said Dr. Park of Olive View–UCLA Medical Center, Los Angeles.

Moreover, there was no difference in operating time or surgical morbidity in a case-control study involving 133 women who underwent hysterectomy with ovarian preservation and salpingectomy and in 433 controls who did not undergo salpingectomy.

Study subjects were women undergoing abdominal, laparoscopic, or vaginal hysterectomy with ovarian preservation. The salpingectomy rate was lowest for vaginal hysterectomy, as visualization of the fallopian tubes is often difficult with that approach. In fact, two of six women who were unable to undergo salpingectomy despite giving consent were unable to have the procedure because of poor visualization of the tubes, Dr. Park said.

The findings are important given that emerging research points to the fallopian tubes as the site of serous carcinogenesis, Dr. Park said.

Though limited by the retrospective, single-center design, this study is the largest known study to date to look at the feasibility and safety of performing salpingectomy at the time of hysterectomy with ovarian preservation, she said.

Long-term follow-up to evaluate the effects of routine bilateral salpingectomy in these subjects is underway, she noted.

Dr. Park reported having no disclosures.

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