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    Techniques for salpingectomy at time of hysterectomy

     

    Once considered an innocent bystander, the fallopian tube is now thought to play an important role in development of one of the most deadly gynecologic cancers. Several studies evaluating risk-reducing salpingo-oophorectomy specimens in women who are BRCA gene mutation carriers implicate the fallopian tube as the most common site of occult carcinomas. Serous tubal intraepithelial carcinomas (STIC), which representative preinvasive fallopian tube pathology, are also identified in these patients, and believed to be a part of the pathway of malignant transformation that results in high-grade serous carcinomas (HGSCs).1-3 Gene expression and molecular profiling studies demonstrate that ovarian HGSCs more closely resemble fallopian tube epithelium than ovarian surface epithelium.4-6 TP53 mutations are extremely common in both STIC lesions and ovarian HGSCs, and more importantly, the particular mutations in these 2 lesions have been shown to be identical.7
    While much of the evidence supporting the fallopian tube as the origin of HGSC is derived from high-risk patients, several studies demonstrate that this is also the case for the remainder of the population at baseline risk, including some research that shows a decreased risk of ovarian cancer in women who have undergone tubal ligation.8-11


    Patients with germline BRCA mutations are particularly predisposed to ovarian cancer. However, 85%–90% of ovarian HGSCs arise in patients without a currently identified genetic susceptibility.12 Nearly 70% of those cancers are thought to arise from the fallopian tube, implying a potential role for salpingectomy as a means for ovarian cancer risk reduction in the general population.4,12 While it remains to be determined whether the risks outweigh the benefits of performing a bilateral salpingectomy as a stand-alone procedure in an average-risk patient, bilateral salpingectomy certainly should be considered in patients who are already undergoing hysterectomy for other indications. The operative safety of salpingectomy in this setting has been demonstrated in a large retrospective cohort study of more than 40,000 women.13

    Malaika W Amneus, MD
    Dr Amneus is a Gynecologic Oncologist at Kaiser Permanente Medical Group, Panorama City and Volunteer Faculty at Olive View-UCLA Medical ...
    Christine H Holschneider, MD
    Dr Holschneider is Professor of Clinical Obstetrics and Gynecology at the David Geffen School of Medicine at UCLA and Chair of the ...

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