Opportunistic salpingectomy: uptake, risks, and complications of a regional initiative for ovarian cancer prevention

Jessica N McAlpine; Gillian E Hanley; Michelle M M Woo; Alicia A Tone; Nirit Rozenberg; Kenneth D Swenerton; C Blake Gilks; Sarah J Finlayson; David G Huntsman; Dianne M Miller; Ovarian Cancer Research Program of British Columbia

doi:10.1016/j.ajog.2014.01.003

Opportunistic salpingectomy: uptake, risks, and complications of a regional initiative for ovarian cancer prevention

Am J Obstet Gynecol. 2014 May;210(5):471.e1-11. doi: 10.1016/j.ajog.2014.01.003. Epub 2014 Jan 9.

Affiliations

¹ Department of Gynecology and Obstetrics Division of Gynecologic Oncology, University of British Columbia and BC Cancer Agency. Electronic address: jessica.mcalpine@vch.ca.
² School of Population and Public Health, Child and Family Research Institute, University of British Columbia.
³ Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency; Center for Translational and Applied Genomics, BC Cancer Agency.
⁴ Division of Gynecologic Oncology, Princess Margaret Cancer Center.
⁵ Center for Translational and Applied Genomics, BC Cancer Agency.
⁶ Department of Medicine, University of British Columbia and BC Cancer Agency.
⁷ Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency.
⁸ Department of Gynecology and Obstetrics Division of Gynecologic Oncology, University of British Columbia and BC Cancer Agency.

PMID: 24412119
DOI: 10.1016/j.ajog.2014.01.003

Abstract

Objective: The purpose of this study was to assess the uptake and perioperative safety of bilateral salpingectomy (BS) as an ovarian cancer risk-reduction strategy in low-risk women after a regional initiative that was aimed at general gynecologists in the province of British Columbia, Canada.

Study design: This population-based retrospective cohort study evaluated 43,931 women in British Columbia from 2008-2011 who underwent hysterectomy that was performed with and without BS or bilateral salpingo-oophorectomy or who underwent surgical sterilization by means of BS or tubal ligation. Parameters that were examined include patient age, operating time, surgical approach, indication, length of hospital stay, and perioperative complications.

Results: There was an increase in the uptake of hysterectomy with BS (5-35%; P < .001) and BS for sterilization (0.5-33%; P < .001) over the study period, particularly in women <50 years old. Minimal additional surgical time is required for hysterectomy with BS (16 minutes; P < .001) and BS for sterilization (10 minutes; P < .001) compared with hysterectomy alone or tubal ligation, respectively. No significant differences were observed in the risks of hospital readmission or blood transfusions in women who underwent hysterectomy with BS (adjusted odds ratio [aOR], 0.91; 95% confidence interval [CI], 0.75-1.10; and aOR, 0.86; 95% CI, 0.67-1.10, respectively) or BS for sterilization (aOR, 0.8; 95% CI, 0.56-1.21; and aOR, 0.75; 95% CI, 0.32-1.73, respectively). From 2008-2011 the proportion of hysterectomies with BS performed by open laparotomy decreased from 77-44% with uptake in laparoscopic, vaginal, and combined procedures (P < .001).

Conclusion: After our 2010 educational initiative, there has been a shift in surgical paradigm in our province. This cancer prevention approach does not increase the risk of operative/perioperative complications and appears both feasible and safe.

Keywords: educational campaign; ovarian cancer; prevention; safety; salpingectomy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
British Columbia
Education, Medical, Continuing
Fallopian Tubes / physiopathology
Female
Gynecology / education
Humans
Hysterectomy / statistics & numerical data
Odds Ratio
Operative Time
Ovarian Neoplasms / physiopathology
Ovarian Neoplasms / prevention & control*
Retrospective Studies
Salpingectomy* / statistics & numerical data
Sterilization, Tubal
Young Adult