A new consensus from the European Society of Gynaecological Oncology (ESGO) recommends considering the removal of fallopian tubes during common pelvic surgeries as a preventative measure against ovarian cancer. This advice stems from growing evidence that the fallopian tubes are a primary site of origin for high-grade serous ovarian cancer, the most common and aggressive form of the disease.The guidance, based on a thorough review of available data, could potentially prevent over 2,000 deaths annually in Europe, offering a significant advancement in proactive women’s health.
A proactive approach to ovarian cancer prevention may lie in removing the fallopian tubes during common pelvic surgeries, according to a recommendation from the European Society of Gynaecological Oncology (ESGO). Ovarian cancer remains a challenging disease to treat, and identifying effective preventative measures is a critical area of research for improving women’s health outcomes.
The proposal, stemming from years of evolving understanding of the disease, centers on recent evidence suggesting that the fallopian tubes are the origin point for many high-grade serous ovarian cancers – the most common type of epithelial ovarian cancer, also known as tubo-ovarian carcinoma. This shift in understanding has led to the exploration of opportunistic salpingectomy, the removal of the fallopian tubes during other surgical procedures, as a preventative measure.
Before issuing the recommendation, ESGO convened a multidisciplinary panel of experts in surgery, oncology, pathology, and public health. The panel conducted a systematic review of existing literature and a multi-round Delphi process to reach a consensus.
ESGO defines opportunistic salpingectomy as the complete, bilateral removal of the fallopian tubes in women at standard population risk, performed during benign pelvic surgery – such as hysterectomy, sterilization, or endometriosis surgery.
The methodology involved an initial screening of 230 studies by a methodologist, followed by a review of 129 articles by working groups to formulate statements. Twenty-one of these studies, along with their respective levels of evidence, were analyzed in detail.
Observational studies, encompassing data from over 3 million women, indicate a reduction in tubo-ovarian cancer (CTO) risk ranging from 20% to 65% among those who underwent bilateral salpingectomy, without any demonstrated negative impact on ovarian function as measured by anti-Müllerian hormone (AMH) levels or ovarian stimulation response. Additional surgical complications are rare, and the incremental cost is low, particularly when performed alongside a planned gynecological procedure.
The ESGO suggests that opportunistic salpingectomy should be considered for all women of reproductive age at standard risk when a pelvic surgical indication exists. For premenopausal women, a clear discussion regarding the procedure’s lack of immediate contraceptive effect and the preservation of ovarian function is essential.
Complete removal of the tubes, including the fimbrial portion extending into the uterus, is crucial. In cases of hysterectomy, ovarian conservation is recommended when age and clinical context allow.
- For women at high risk (carrying BRCA1/2 mutations or with Lynch syndrome), opportunistic salpingectomy is not a substitute for recommended prophylactic salpingo-oophorectomy, but it may be a transitional step (“two-stage approach”) for younger women wishing to delay surgical menopause.
- Pathological considerations are important: all removed fallopian tubes should undergo histological examination following the SEE-FIM protocol to identify potential serous tubal intraepithelial carcinoma (STIC) lesions. If STIC is detected, a specific oncological evaluation is required.
- Implementation strategies: ESGO encourages training for gynecological surgeons in standardized salpingectomy techniques, integration of the measure into national ovarian cancer prevention programs, and systematic documentation in surgical registries.
Over 2,000 Deaths Potentially Prevented Annually
European modeling estimates that widespread adoption of opportunistic salpingectomy during hysterectomies or sterilizations could prevent more than 2,000 deaths per year in the long term. The strategy is considered cost-effective and safe, particularly in healthcare systems with broad access to planned gynecological surgery. Patient education, standardization of the procedure, and collaboration between professional societies (ESGO, EBCOG, and national societies) are key steps.
The authors acknowledge the lack of randomized controlled trials, although prospective studies (NOTABLE, TUBA, HOPPSA) are currently underway. Long-term monitoring of ovarian function and patient satisfaction will require extensive cohort studies.
Limited Data for Young Women
Regret related to fertility after opportunistic salpingectomy has not been specifically studied in this context. However, for women seeking sterilization, salpingectomy should be the preferred method over tubal ligation, given its potential to reduce the risk of tubo-ovarian cancer. Currently, opportunistic salpingectomy is not recommended during emergency surgery or when future fertility desires are unknown.
The ESGO consensus concludes that opportunistic salpingectomy represents a realistic, simple, and effective preventative measure against tubo-ovarian carcinoma in the general population. Its integration into routine gynecological practice, with adherence to information guidelines and surgical quality standards, could represent a major advancement comparable to HPV vaccination in cervical cancer prevention.
