Advertisement

Prophylactic bilateral salpingectomy (PBS) to reduce ovarian cancer risk incorporated in standard premenopausal hysterectomy: complications and re-operation rate

  • J. Vorwergk
  • M. P. Radosa
  • K. Nicolaus
  • N. Baus
  • J. Jimenez Cruz
  • M. Rengsberger
  • M. Gajda
  • H. Diebolder
  • I. B. RunnebaumEmail author
Original Article - Clinical Oncology

Abstract

Purpose

Hysterectomy for benign conditions can be combined with bilateral salpingectomy to prevent re-intervention for malignant or benign fallopian tube pathologies. The objective of this study was to evaluate the benefit of prophylactic bilateral salpingectomy (PBS) in standard hysterectomy in premenopausal women.

Methods

This retrospective cohort study included all premenopausal patients at our institution who underwent laparoscopically assisted vaginal hysterectomy (LAVH) without oophorectomy for benign pathologies between 2001 and 2007 [PBS group (LAVH + PBS), 2006–2007; non-PBS group (LAVH without PBS), 2001–2005]. Electronic and paper-based files as well as questionnaire responses were analyzed. In 2010, a survey on patients of a non-BRCA background with and without PBS was requested to complete a standardized questionnaire. Data were analyzed for differences between both subgroups regarding surgical outcome and adnexal pathologies as reported in the postoperative follow-up.

Results

Surgical outcomes of 540 patients (PBS: 127; non-PBS: 413) revealed no difference between groups. No preneoplastic or malignant lesions were diagnosed in the fallopian tubes. Follow-up (non-PBS 92 months, PBS 55 months; p < 0.01) responses from 295 (54.6 %) patients showed a higher incidence of benign adnexal pathologies in the non-PBS group (26.9 vs. 13.9 %; p = 0.02). The rate of LAVH-related surgical re-intervention was higher in the non-PBS group (12.56 vs. 4.16 %; p = 0.04). No malignant neoplasm was reported in the cohort.

Conclusions

PBS did not increase the complication rate and reduced the incidence of adnexal pathologies requiring surgical re-intervention. Prospective trials should clarify the impact of PBS on cancer mortality.

Keywords

Ovarian cancer Prophylactic salpingectomy Hysterectomy Risk-reducing bilateral salpingo-oophorectomy Premenopausal women 

Notes

Conflict of interest

None.

References

  1. Callahan MJ, Crum CP et al (2007) Primary fallopian tube malignancies in BRCA-positive women undergoing surgery for ovarian cancer risk reduction. J Clin Oncol 25(25):3985–3990CrossRefPubMedGoogle Scholar
  2. Childers JM, Surwit EA (1992) Combined laparoscopic and vaginal surgery for the management of two cases of stage I endometrial cancer. Gynecol Oncol 45(1):46–51CrossRefPubMedGoogle Scholar
  3. Chornokur G, Amankwah EK, Schildkraut JM, Phelan CM (2013) Global ovarian cancer health disparities. Gynecol Oncol 129(1):258–264CrossRefPubMedGoogle Scholar
  4. Cibula D, Widschwendter M et al (2011) Tubal ligation and the risk of ovarian cancer: review and meta-analysis. Hum Reprod Update 17(1):55–67CrossRefPubMedGoogle Scholar
  5. Crum CP, Drapkin R et al (2007) The distal fallopian tube: a new model for pelvic serous carcinogenesis. Curr Opin Obstet Gynecol 19(1):3–9CrossRefPubMedGoogle Scholar
  6. Dar P, Sachs GS et al (2000) Ovarian function before and after salpingectomy in artificial reproductive technology patients. Hum Reprod 15(1):142–144CrossRefPubMedGoogle Scholar
  7. Devendra K, Tay SK (2002) Laparoscopically-assisted vaginal hysterectomy (LAVH)—an alternative to abdominal hysterectomy. Singapore Med J 43(3):138–142PubMedGoogle Scholar
  8. Dietl J, Wischhusen J et al (2011) The post-reproductive Fallopian tube: better removed? Hum Reprod 26(11):2918–2924CrossRefPubMedGoogle Scholar
  9. Dindo D, Demartines N et al (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentralGoogle Scholar
  10. Ghezzi F, Cromi A et al (2009) Infectious morbidity after total laparoscopic hysterectomy: does concomitant salpingectomy make a difference? BJOG 116(4):589–593CrossRefPubMedGoogle Scholar
  11. Gill SE, Mills BB (2013) Physician opinions regarding elective bilateral salpingectomy with hysterectomy and for sterilization. J Minim Invasive Gynecol 20(4):517–521CrossRefPubMedGoogle Scholar
  12. Guldberg R, Lidegaard O et al (2013) Salpingectomy as standard at hysterectomy? A Danish cohort study, 1977–2010. BMJ Open 3(6). doi: 10.1136/bmjopen-2013-002845
  13. Jarboe EA, Miron A et al (2009) Coexisting intraepithelial serous carcinomas of the endometrium and fallopian tube: frequency and potential significance. Int J Gynecol Pathol 28(4):308–315CrossRefPubMedGoogle Scholar
  14. Kindelberger DW, Lee Y et al (2007) Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: evidence for a causal relationship. Am J Surg Pathol 31(2):161–169CrossRefPubMedGoogle Scholar
  15. Medeiros F, Muto MG et al (2006) The tubal fimbria is a preferred site for early adenocarcinoma in women with familial ovarian cancer syndrome. Am J Surg Pathol 30(2):230–236CrossRefPubMedGoogle Scholar
  16. Mingels MJ, van Ham MA et al (2013) Mullerian precursor lesions in serous ovarian cancer patients: using the SEE-Fim and SEE-End protocol. Mod Pathol. doi: 10.1038/modpathol.2013.212
  17. Morelli M, Venturella R et al (2013) Prophylactic salpingectomy in premenopausal low-risk women for ovarian cancer: primum non nocere. Gynecol Oncol 129(3):448–451CrossRefPubMedGoogle Scholar
  18. Morse AN, Hammer RA, et al (2002) Does hysterectomy without adnexectomy in patients with prior tubal interruption increase the risk of subsequent hydrosalpinx? Am J Obstet Gynecol 187(6):1483–1485; discussion 1485–1486Google Scholar
  19. Morse AN, Schroeder CB et al (2006) The risk of hydrosalpinx formation and adnexectomy following tubal ligation and subsequent hysterectomy: a historical cohort study. Am J Obstet Gynecol 194(5):1273–1276CrossRefPubMedGoogle Scholar
  20. Nahas E, Pontes A et al (2003) Inhibin B and ovarian function after total abdominal hysterectomy in women of reproductive age. Gynecol Endocrinol 17(2):125–131CrossRefPubMedGoogle Scholar
  21. Owens WD, Felts JA et al (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49(4):239–243CrossRefPubMedGoogle Scholar
  22. Piek JM, van Diest PJ et al (2001) Tubal ligation and risk of ovarian cancer. Lancet 358(9284):844CrossRefPubMedGoogle Scholar
  23. Przybycin CG, Kurman RJ et al (2010) Are all pelvic (nonuterine) serous carcinomas of tubal origin? Am J Surg Pathol 34(10):1407–1416CrossRefPubMedGoogle Scholar
  24. Radosa JC, Radosa MP et al (2013) Five minutes of extended assisted ventilation with an open umbilical trocar valve significantly reduces postoperative abdominal and shoulder pain in patients undergoing laparoscopic hysterectomy. Eur J Obstet Gynecol Reprod Biol 171(1):122–127CrossRefPubMedGoogle Scholar
  25. Repasy I, Lendvai V et al (2009) Effect of the removal of the Fallopian tube during hysterectomy on ovarian survival: the orphan ovary syndrome. Eur J Obstet Gynecol Reprod Biol 144(1):64–67CrossRefPubMedGoogle Scholar
  26. Rezvani M, Shaaban AM (2011) Fallopian tube disease in the nonpregnant patient. Radiographics 31(2):527–548CrossRefPubMedGoogle Scholar
  27. Runnebaum IB, Tong XW et al (1994) p53 mutant His175 identified in a newly established fallopian tube carcinoma cell line secreting interleukin 6. FEBS Lett 353(1):29–32CrossRefPubMedGoogle Scholar
  28. Sezik M, Ozkaya O et al (2007) Total salpingectomy during abdominal hysterectomy: effects on ovarian reserve and ovarian stromal blood flow. J Obstet Gynaecol Res 33(6):863–869CrossRefPubMedGoogle Scholar
  29. Singla A (2007) An unusual case of torsion hydrosalpinx after hysterectomy: a case report. Aust N Z J Obstet Gynaecol 47(3):256–257CrossRefPubMedGoogle Scholar
  30. Statistisches Bundesamt (2011) Gesundheit. Grunddaten der Krankenhäuser. Fachserie 12:6.1.1Google Scholar
  31. Strandell A, Lindhard A et al (2001) Prophylactic salpingectomy does not impair the ovarian response in IVF treatment. Hum Reprod 16(6):1135–1139CrossRefPubMedGoogle Scholar
  32. Timor-Tritsch IE, Monteagudo A et al (2010) Three-dimensional ultrasound inversion rendering technique facilitates the diagnosis of hydrosalpinx. J Clin Ultrasound 38(7):372–376PubMedGoogle Scholar
  33. Whiteman MK, Hillis SD et al (2008) Inpatient hysterectomy surveillance in the United States, 2000–2004. Am J Obstet Gynecol 198(1):34e31–34e37Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • J. Vorwergk
    • 1
  • M. P. Radosa
    • 1
  • K. Nicolaus
    • 1
  • N. Baus
    • 1
  • J. Jimenez Cruz
    • 1
  • M. Rengsberger
    • 1
  • M. Gajda
    • 2
  • H. Diebolder
    • 1
  • I. B. Runnebaum
    • 1
    Email author
  1. 1.Department of Gynecology and Obstetrics, Jena University HospitalFriedrich Schiller UniversityJenaGermany
  2. 2.Department of PathologyJena University Hospital, Friedrich Schiller UniversityJenaGermany

Personalised recommendations