Ovarian cancer is currently the fifth leading cause of death in women. In addition, the symptoms of this cancer, such as fatigue or abdominal pain, are not very specific. This means that the diagnosis of ovarian cancer in most cases occurs late, making the prognosis unfavourable.
Recent studies indicate that most ovarian cancers originate in the fallopian tubes. Therefore, since 2010, many gynaecological professionals have recommended a salpingectomy (that is, the removal of the fallopian tubes) in women who have to undergo other gynaecological surgery if they no longer wish to get pregnant. It is estimated that this would prevent a large number of cases of ovarian cancer without greatly increasing the time or complexity of the surgery.
These types of operations are called opportunistic, since they take advantage of the fact that the person has to undergo an operation for another reason. This could be carried out, for example, if a patient has to have a tubal ligation or a hysterectomy (uterus removal).
It is estimated that the removal of the fallopian tubes in women undergoing gynaecological surgery could reduce mortality from ovarian cancer by up to 14%. However, more studies still need to be done to assess the long-term impact of removing the fallopian tubes. At the moment, some research indicates that this procedure does not affect ovarian reserve or the early onset of menopause. Thanks to these good results, over 70% of gynaecological surgeons in the US in 2015 were carrying out this practice.
One of the next steps in extending this preventive measure is to follow this practice when performing abdominal surgery. For example, appendicitis or gallbladder removal. Despite the current lack of long-term data, there is enough evidence for gastrointestinal surgeons to support this initiative. Of course, this surgery should always be practised with the informed consent of the patient, after receiving all the necessary information and advice.
Prognosis of Ovarian Cancer
The median survival rate for ovarian cancer after five years from diagnosis is less than 50% of cases. If the cancer is diagnosed and treated when it is located only in the ovaries, before it spreads to other parts of the body, the five-year survival rate is about 90%. However, only 25% of women with ovarian cancer are diagnosed at the early stage. These survival rates vary according to the type of ovarian cancer.
Thus, preventive measures such as the one proposed in this article are highly important. Despite being an invasive process, the removal of the fallopian tubes could significantly reduce the number of women affected by this disease and, therefore, save lives.
INFORMATION DOCUMENTED BY:
Dr Francisco Carmona, Head of Gynaecology Department at Hospital Clínic, Barcelona
Mariona Rius, José Carugno, Maurico S Abrao, Francisco Carmona. Opportunistic Salpingectomy for Ovarian Cancer Prevention: A Call for Action. J Am Coll Surg 2023 Apr