Should Fallopian Tubes Be Removed During Hysterectomy Procedures? – A Statement by AGO Ovar

Introduction

The detection of premalignant cells in the epithelia of the fallopian tubes has revolutionized the theories on the genesis of ovarian cancer. Occurrence of serous tubal intraepithelial carcinomas (STIC) has been established in carriers of the germline mutation of the BRCA1/2 gene, with STICs now considered as a possible origin of serous high-grade carcinomas which frequently occur in this patient population. Bilateral salpingo-oophorectomy leads to a significant decrease in the risk of developing this carcinoma. It is recommended that this prophylactic surgery be performed between the age of 40 and 45 years.

Removal of the fallopian tubes has been propagated analogously in women with no proven genetic or identifiable familial risk of ovarian cancer. Fallopian tube removal has been proposed during surgery for benign disease, for example in women in whom hysterectomy is indicated. Such “prophylactic” or “opportunistic” salpingectomy procedures could prevent carcinoma development in later years. Critics warn that such an intervention could result in inadequate blood supply to the ovaries, resulting in morbidity associated with early hormone deficiency. It is still unclear how effective opportunistic salpingectomy could be as a primary prevention strategy and how such a strategy should best be implemented.

• References

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