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According to the American College of Obstetricians and Gynecologists 2019 guidelines, bilateral salpingectomy appears to be safe and does not increase the risk of short-term complications, such as blood transfusions, readmissions, postoperative complications, infections, or fever compared with hysterectomy alone or tubal ligation. Additionally, ovarian function does not appear to be affected by salpingectomy, based on surrogate serum markers or response to in vitro fertilization. More future research will help establish the long-term benefits and risks of bilateral salpingectomy in the context of gynecological and non-gynecological surgeries.

Several population-based studies of those not known to be at increased risk for developing ovarian cancer (ie, no genetic predisposition) have shown a significant decrease in the risk of developing ovarian cancer following bilateral salpingectomy. Prospective, controlled long-term studies of bilateral salpingectomy and ovarian cancer incidence are ongoing and projected to support these findings.

Several retrospective, population-based observational studies have demonstrated a reduction in the risk of developing ovarian cancer among patients who underwent complete bilateral salpingectomy at the time of abdominal surgery for a benign condition.

• A team of researchers in Canada have been tracking the incidence of high-grade serous cancer for years in 26,000 women who had bilateral salpingectomy during hysterectomy or for tubal sterilization. They have observed substantially fewer diagnoses in these women compared to women who did not undergo salpingectomy
• A population-based cohort study in Sweden showed a 65% risk reduction in ovarian cancer among women who underwent complete bilateral salpingectomy for surgical tubal sterilization.
• A meta-analysis of three studies of women undergoing hysterectomy for benign indications showed women who underwent bilateral salpingectomy at the time of hysterectomy had a lower risk of developing ovarian cancer when compared with women who did not undergo salpingectomy. These patients were monitored for a minimum of 30 years after salpingectomy.

Although bilateral salpingectomy can significantly decrease the risk of ovarian cancer, it does not eliminate the risk of ovarian cancer altogether. Ovarian cancer is a highly heterogeneous group of cancers that includes 5 major subtypes of epithelial ovarian cancer: high-grade serous carcinoma (HGSC), which accounts for approximately 70-80% of all ovarian cancer cases; low-grade serous carcinoma (LGSC); and endometrioid, clear cell, and seromucinous carcinomas. While the link between HGSC and its origin in the fallopian tubes has been established, this is not the case for all types of epithelial ovarian cancer. The non-epithelial types of ovarian cancer (these make up 10% of ovarian cancer overall)—sex cord stromal and germ cell ovarian cancers—are thought to start primarily in the ovary and not in the fallopian tube. Healthcare professionals should counsel women about the limitations of bilateral salpingectomy for ovarian cancer prevention and should make sure that their patients are aware of the potential signs and symptoms of ovarian cancer.

Identifying the appropriate patient for bilateral salpingectomy is important. Based on the current state of the science, eligible patients:

• Desire permanent contraception
• Have no increased genetic risk for developing ovarian cancer
• Patients with a family history of ovarian cancer should have germline genetic testing and counseling to best choose between bilateral salpingectomy and bilateral salpingo-oophorectomy

Patients with a germ-line BRCA mutation have a high lifetime risk of developing ovarian cancer (11% to 44%). For these patients, prophylactic bilateral salpingo-oophorectomy is the standard of care to reduce ovarian cancer risk. Prophylactic bilateral salpingectomy with delayed oophorectomy as a preventative strategy is under intense investigation. Learn more at:

https://clinicaltrials.gov/study/NCT05287451

https://clinicaltrials.gov/study/NCT02760849

https://clinicaltrials.gov/study/NCT02321228

https://clinicaltrials.gov/study/NCT04294927

https://clinicaltrials.gov/study/NCT04251052

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