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Extending the safety evidence for opportunistic salpingectomy in prevention of ovarian cancer: a cohort study from British Columbia, Canada

      Background

      Recent evidence has suggested that the fallopian tube may often be the site of origin for the most common and lethal form of ovarian cancer. As a result, many Colleges of Obstetrics and Gynecology, including the American College of Obstetricians and Gynecology, are recommending surgical removal of the fallopian tube (bilateral salpingectomy) at the time of other gynecologic surgeries (particularly hysterectomy and tubal sterilization) in women at general population risk for ovarian cancer, collectively referred to as opportunistic salpingectomy.

      Objective

      Previous research with the use of hospital data has indicated good perioperative safety of opportunistic salpingectomy, but no data on minor complications have been presented. Herein, we examine whether women who undergo opportunistic salpingectomy are at increased risk of minor complications after surgery.

      Study Design

      We identified all women in British Columbia who underwent opportunistic salpingectomy between 2008 and 2014 and examined all physician visits in the 2 weeks after discharge from the hospital. We compared women who underwent opportunistic salpingectomy at hysterectomy with women who underwent hysterectomy alone and women who underwent opportunistic salpingectomy for sterilization with women who underwent tubal ligation. We examined visits for surgical infection, surgical complication, orders for laboratory tests, and orders for imaging (x-ray, ultrasound scan, or computed tomography scan) and whether women who underwent opportunistic salpingectomy were more likely to fill a prescription for an antibiotic or analgesic in the 2 weeks after discharge from the hospital. We calculated adjusted odds ratios for these outcomes, adjusting for other gynecologic conditions, surgical approach, and patient age.

      Results

      We included 49,275 women who had undergone a hysterectomy alone, a hysterectomy with opportunistic salpingectomy, a hysterectomy with bilateral salpingo-oophorectomy, a tubal ligation, or an opportunistic salpingectomy for sterilization. In women who had undergone opportunistic salpingectomy, there was no increased risk for physician visits for surgical infection, surgical complication, ordering a laboratory test, or ordering imaging in the 2 weeks after discharge. There was no increased risk of filling a prescription for an antibiotic. However, women who underwent opportunistic salpingectomy were at approximately 20% increased odds of filling a prescription for an analgesic in the 2 weeks after discharge from the hospital (adjusted odds ratio, 1.23; 95% confidence interval, 1.15–1.32 for hysterectomy with opportunistic salpingectomy; adjusted odds ratio, 1.21; 95% confidence interval, 1.14–1.29 for opportunistic salpingectomy for sterilization).

      Conclusion

      We report no differences in minor complications between women who undergo opportunistic salpingectomy and women who undergo hysterectomy alone or tubal ligation, except for a slightly increased likelihood of filling a prescription for analgesic medication in the immediate 2 weeks after discharge.

      Key words

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      References

        • Rosenthal A.N.
        • Fraser L.
        • Manchanda R.
        • et al.
        Results of annual screening in phase I of the United Kingdom familial ovarian cancer screening study highlight the need for strict adherence to screening schedule.
        J Clin Oncol. 2013; 31: 49-57
        • Buys S.S.
        • Partridge E.
        • Black A.
        • et al.
        Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial.
        JAMA. 2011; 305: 2295-2303
        • Kobayashi H.
        • Yamada Y.
        • Sado T.
        • et al.
        A randomized study of screening for ovarian cancer: a multicenter study in Japan.
        Int J Gynecol Cancer. 2008; 18: 414-420
        • Menon U.
        • Gentry-Maharaj A.
        • Hallett R.
        • et al.
        Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).
        Lancet Oncol. 2009; 10: 327-340
        • Menon U.
        • Ryan A.
        • Kalsi J.
        • et al.
        Risk algorithm using serial biomarker measurements doubles the number of screen-detected cancers compared with a single-threshold rule in the United Kingdom Collaborative Trial of Ovarian Cancer Screening.
        J Clin Oncol. 2015; 33: 2062-2071
        • Gao F.F.
        • Bhargava R.
        • Yang H.
        • Li Z.
        • Zhao C.
        Clinicopathologic study of serous tubal intraepithelial carcinoma with invasive carcinoma: is serous tubal intraepithelial carcinoma a reliable feature for determining the organ of origin?.
        Hum Pathol. 2013; 44: 1534-1543
        • Kindelberger D.W.
        • Lee Y.
        • Miron A.
        • et al.
        Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: evidence for a causal relationship.
        Am J Surg Pathol. 2007; 31: 161-169
        • Karst A.M.
        • Levanon K.
        • Drapkin R.
        Modeling high-grade serous ovarian carcinogenesis from the fallopian tube.
        Proc Natl Acad Sci U S A. 2011; 108: 7547-7552
        • Singh N.
        • Gilks C.B.
        • Wilkinson N.
        • McCluggage W.G.
        Assessment of a new system for primary site assignment in high-grade serous carcinoma of the fallopian tube, ovary, and peritoneum.
        Histopathology. 2015; 67: 331-337
      1. The Society of Gynecologic Oncology of Canada. GOC Statement regarding salpingectomy and ovarian cancer prevention. Available at: https://g-o-c.org/wp-content/uploads/2015/09/7GOCStmt_2011Sep_SalpOvCa_EN.pdf. Accessed July 9, 2018.

      2. Society of Gynecologic Oncology. SGO Clinical Practice Statement: salpingectomy for ovarian cancer. Available at: https://www.sgo.org/clinical-practice/guidelines/sgo-clinical-practice-statement-salpingectomy-for-ovarian-cancer-prevention/. Accessed July 9, 2018.

        • American College of Obstetricians and Gynecologists
        Committee Opinion No. 620: salpingectomy for ovarian cancer prevention.
        Obstet Gynecol. 2015; 125: 279-281
        • Salvador S.
        • Scott S.
        • Fancis J.A.
        • Agrawal A.
        • Giede C.
        No. 344–Opportunistic salpingectomy and other methods of risk reduction for ovarian/fallopian tube/peritoneal cancer in the general population.
        J Obstet Gynaecol Can. 2017; 39: 480-493
        • Hicks-Courant K.D.
        Growth in salpingectomy rates in the United States since 2000.
        Am J Obstet Gynecol. 2016; 215: 666-667
        • Mikhail E.
        • Salemi J.L.
        • Mogos M.F.
        • Hart S.
        • Salihu H.M.
        • Imudia A.N.
        National trends of adnexal surgeries at the time of hysterectomy for benign indication, United States, 1998-2011.
        Am J Obstet Gynecol. 2015; 213: 713.e1-713.e13
        • Hanley G.E.
        • McAlpine J.N.
        • Pearce C.L.
        • Miller D.
        The performance and safety of bilateral salpingectomy for ovarian cancer prevention in the United States.
        Am J Obstet Gynecol. 2017; 216: 270.e1-270.e9
        • Hanley G.
        • McAlpine J.
        • Kwon J.
        • Mitchell G.
        Opportunistic salpingectomy for ovarian cancer prevention.
        Gynaecol Oncol Res Pract. 2015; 2: 1-9
        • McAlpine J.N.
        • Hanley G.E.
        • Woo M.M.
        • et al.
        Opportunistic salpingectomy: uptake, risks, and complications of a regional initiative for ovarian cancer prevention.
        Am J Obstet Gynecol. 2014; 210: 471.e1-471.e11
        • Sandoval C.
        • Fung-Kee-Fung M.
        • Gilks B.
        • Murphy K.J.
        • Rahal R.
        • Bryant H.
        Examining the use of salpingectomy with hysterectomy in Canada.
        Curr Oncol. 2013; 20: 173-175
      3. Canadian Institute for Health Information (2015). Discharge Abstract Database (Hospital Separations). V2. Population Data BC. Data Extract. MOH (2015).

      4. British Columbia Ministry of Health (2015). Medical Services Plan (MSP) Payment Information File.V2. Population Data BC. Data extract. MOH. 2015. Available at: www.population.bc.ca/data. Accessed June 8, 2018.

      5. BC Ministry of Health (2015). PharmaNet. V2. BC Ministry of Health. Data Extract. Data stewardship committee (2015). Available at: www.popdata.bc.ca/data. Accessed June 8, 2018.

        • Lim A.W.W.
        • Mesher D.
        • Gentry-Maharaj A.
        • et al.
        Time to diagnosis of type I or II invasive epithelial ovarian cancers: a multicentre observational study using patient questionnaire and primary care records.
        BJOG. 2016; 123: 1012-1020
      6. Surveillance Epidemiology and End Results Program. Ovary Cancer Survival Statistics. Available at: https://seer.cancer.gov/statfacts/html/ovary.html. Accessed June 8, 2018.

        • Tone A.A.
        • Salvador S.
        • Finlayson S.J.
        • et al.
        The role of the fallopian tube in ovarian cancer.
        Clin Adv Hematol Oncol. 2012; 10: 296-306
        • Yoon S.H.
        • Kim S.N.
        • Shim S.H.
        • Kang S.B.
        • Lee S.J.
        Bilateral salpingectomy can reduce the risk of ovarian cancer in the general population: a meta-analysis.
        Eur J Cancer. 2016; 55: 38-46
        • Lessard-Anderson C.R.
        • Handlogten K.S.
        • Molitor R.J.
        • et al.
        Effect of tubal sterilization technique on risk of serous epithelial ovarian and primary peritoneal carcinoma.
        Gynecol Oncol. 2014; 135: 423-427
        • Madsen C.
        • Baandrup L.
        • Dehlendorff C.
        • Kjaer S.K.
        Tubal ligation and salpingectomy and the risk of epithelial ovarian cancer and borderline ovarian tumors: a nationwide case-control study.
        Acta Obstet Gynecol Scand. 2015; 94: 86-94
        • Falconer H.
        • Yin L.
        • Gronberg H.
        • Altman D.
        Ovarian cancer risk after salpingectomy: a nationwide population-based study.
        J Natl Cancer Inst. 2015; 107
        • Kwon J.S.
        • McAlpine J.N.
        • Hanley G.E.
        • et al.
        Costs and benefits of opportunistic salpingectomy as an ovarian cancer prevention strategy.
        Obstet Gynecol. 2015; 152: 338-345