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Reply to a question regarding ovarian cancer prevention with partial salpingectomy vs complete

      Dr Pitsos brings up a good point that has already been answered, at least partially, in the literature.
      • Pitsos M.
      A partial salpingectomy paper should not be considered in a meta-analysis for salpingectomy.
      Several studies, most notably Lessard-Anderson et al,
      • 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.
      have shown that a partial salpingectomy, or even just a distal fimbriectomy, does reduce the risk of epithelial ovarian cancer more than nonexcising procedures. Clearly, this begs the next question, which is how much of the tube needs to be removed to gain this advantage. Although it is true that Committee Opinion 774
      ACOG Committee Opinion No. 774: opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention.
      does recommend removal up to the uterotubal junction, the opinion acknowledges that there are interstitial portions of the tube that will not be removed. Therefore, almost any salpingectomy could be considered by some a partial salpingectomy. As a result, we were placed in a difficult position as authors by choosing where to draw the line between excisional sterilization procedure and partial salpingectomy. After author discussion, and in our best attempt to comply with the Cochrane guidelines, we felt that if the authors of a study thought they were performing a salpingectomy, then we would accept this regardless of completeness. We stand by this decision.
      As for the statistical contribution of the Rodriguez et al
      • Rodriguez M.I.
      • Seuc A.
      • Sokal D.C.
      Comparative efficacy of postpartum sterilisation with the titanium clip versus partial salpingectomy: a randomised controlled trial.
      paper to our analysis, it is truly minimal. In fact, the only outcome from the Rodriguez et al
      • Rodriguez M.I.
      • Seuc A.
      • Sokal D.C.
      Comparative efficacy of postpartum sterilisation with the titanium clip versus partial salpingectomy: a randomised controlled trial.
      paper that was reported in our meta-analysis was the rate of postoperative pregnancies. This was the only study that reported this outcome, and our conclusions were that the results were not statistically significant. Hence, the inclusion of this study had very little impact on our analyses, and its inclusion or exclusion would not change our conclusions in any way.

      References

        • Pitsos M.
        A partial salpingectomy paper should not be considered in a meta-analysis for salpingectomy.
        Am J Obstet Gynecol. 2021; 225: 694
        • 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
      1. ACOG Committee Opinion No. 774: opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention.
        Obstet Gynecol. 2019; 133: e279-e284
        • Rodriguez M.I.
        • Seuc A.
        • Sokal D.C.
        Comparative efficacy of postpartum sterilisation with the titanium clip versus partial salpingectomy: a randomised controlled trial.
        BJOG. 2013; 120: 108-112

      Linked Article

      • A partial salpingectomy paper should not be considered in a meta-analysis for salpingectomy
        American Journal of Obstetrics & GynecologyVol. 225Issue 6
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          I read with great interest the systematic review and meta-analysis by Mills et al1 on salpingectomy vs tubal ligation for sterilization. The authors refer to Committee Opinion number 774, in which salpingectomy is described as removal of the tube completely from its fimbriated end up to the uterotubal junction.2 However, the authors include in the studies (Table) a study by Rodriguez et al3 that compares partial salpingectomy with bilateral tubal ligation. They also present data on the risk of postoperative pregnancy (Figure 9), and they do not specify in the text that this refers to partial salpingectomy.
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