Persistence of fimbrial tissue on the ovarian surface after salpingectomy

Carmen Gan; Rashna Chenoy; Dhivya Chandrasekaran; Elly Brockbank; Antony Hollingworth; Sotiris Vimplis; Alexandra C Lawrence; Arjun R Jeyarajah; David Oram; Nandita Deo; Jamna Saravanamuthu; Sarah S Lam; Asma Faruqi; Naveena Singh; Ranjit Manchanda

doi:10.1016/j.ajog.2017.06.004

Persistence of fimbrial tissue on the ovarian surface after salpingectomy

Am J Obstet Gynecol. 2017 Oct;217(4):425.e1-425.e16. doi: 10.1016/j.ajog.2017.06.004. Epub 2017 Jun 10.

Authors

Affiliations

¹ Department of Gynaecological Oncology, Royal London Hospital, Whitechapel, London, UK.
² Department of Obstetrics and Gynaecology, Newham University Hospital, London, UK.
³ Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, UK.
⁴ Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, London, UK.
⁵ Department of Histopathology, Royal London Hospital, London, UK.
⁶ Department of Gynaecological Oncology, Royal London Hospital, Whitechapel, London, UK; Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, UK. Electronic address: r.manchanda@qmul.ac.uk.

PMID: 28610900
DOI: 10.1016/j.ajog.2017.06.004

Abstract

Background: Salpingectomy is recommended as a risk-reducing strategy for epithelial tubo-ovarian cancer. The gold standard procedure is complete tubal excision.

Objective: The purpose of this study was to assess the presence of residual fimbrial/tubal tissue on ovarian surfaces after salpingectomy.

Study design: Prospective analysis of patients who underwent salpingo-oophorectomy with or without hysterectomy for benign indications, early cervical cancer, or low-risk endometrial cancer at a UK National Health Service Trust. Salpingectomy with or without hysterectomy was performed initially, followed by oophorectomy within the same operation. Separately retrieved tubes and ovaries were sectioned serially and examined completely histologically. The main outcome measure was histologically identified fimbrial/ tubal tissue on ovarian surface. Chi-square/Fisher's exact tests were used to evaluate categoric variables.

Results: Twenty-five consecutive cases (mean age, 54.8 ± 5.0 years) that comprised 41 adnexae (unilateral, 9; bilateral, 16) were analyzed. Seventeen (68.0%), 5 (20.0%), and 3 (12.0%) procedures were performed by consultant gynecologists, subspecialty/specialist trainees, and consultant gynecologic oncologists, respectively. Twelve of 25 procedures (48.0%) were laparoscopic, and 13 of 25 procedures (52.0%) involved laparotomy. Four of 25 patients (16.0%; 95% confidence interval, 4.5-36.1%) or 4 of 41 adnexae (9.8%; 95% confidence interval, 2.7-23.1%) showed residual microscopic fimbrial tissue on the ovarian surface. Tubes/ovaries were free of adhesions in 23 cases. Two cases had dense adnexal adhesions, but neither had residual fimbrial tissue on the ovary. Residual fimbrial tissue was not associated significantly with surgical route or experience (consultant, 3/20 [15%]; trainee, 1/5 [20%]; P=1.0).

Conclusion: Residual fimbrial tissue remains on the ovary after salpingectomy in a significant proportion of cases and could impact the level of risk-reduction that is obtained.

Keywords: high-grade serous carcinoma; ovarian cancer; ovarian surface; residual fimbrial tissue; salpingectomy.

Publication types

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

MeSH terms

Fallopian Tubes / pathology*
Female
Humans
Hysterectomy
Middle Aged
Ovary / pathology*
Prospective Studies
Salpingectomy*