Opportunistic bilateral salpingectomy during benign gynecological surgery for ovarian cancer prevention: a survey of Gynecologic Oncology Committee of Japan Society of Obstetrics and Gynecology

Abstract

ObjectiveRecent evidence has supported the concept that epithelial ovarian cancer (EOC) arises from the cells of the fallopian tube or endometrium. This study investigated current practice in Japan with respect to performing opportunistic bilateral salpingectomy (OBS) during gynecological surgery for benign disease for Ovarian Cancer Prevention.MethodsWe mailed a questionnaire to 767 hospitals and clinics, comprising 628 accredited training institutions of the Japan Society of Obstetrics and Gynecology (JSOG), Japan Society of Gynecologic Oncology (JSGO), or Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy (JSGOE) and 139 private institutions with at least one JSGOE-certified licensed gynecologic laparoscopist.ResultsAmong the 767 institutions, 444 (57.9%) provided responses, including 91 (20.6%) that were both JSGOE and JSGO accredited, 71 (16.0%) that were only JSGO accredited, 88 (19.8%) that were only JSGOE accredited, and 194 (43.7%) that were unaccredited. It was found that awareness and performance of OBS largely depended on the JSGO and/or JSGOE accreditation status. OBS was only performed at 54.0% of responding institutions and just 6.8% of the institutions were willing to participate in randomized controlled trials to validate this method for reducing the incidence of ovarian cancer.ConclusionThe JSOG Gynecologic Tumor Committee will announce its opinion on salpingectomy for ovarian cancer prevention to all JSOG members and will develop a system for monitoring the number of OBS procedures in Japan.

Bilateral salpingectomy to reduce the risk of ovarian/fallopian/peritoneal cancer in women at average risk: a position statement of the Korean Society of Obstetrics and Gynecology (KSOG)

“…In Austria, 70% (269/382) of the respondents stated that they would offer or discuss prophylactic salpingectomy in average-risk women undergoing gynecological surgery for benign indications, and that salpingectomy was the preferred method for surgical sterilization at the time of cesarean delivery [ 51 53 ]. Prophylactic salpingectomy at the time of hysterectomy for benign disease was applied to women in 70–80% of institutions accredited by an academic society and in 50–65% of institutions not accredited by an academic society in Japan [ 54 ]. In China, the rate of bilateral salpingectomy increased threefold (from 22% to 60%) from 2007 to 2017 [ 55 ].…”

Should national societies recommend opportunistic salpingectomy?

“…Has practice changed? In this issue of Journal of Gynecologic Oncology , Mikami et al [ 6 ] report the results of a survey of 767 institutions in Japan, a country where the professional society, the Japan Society of Gynecologic Oncology (JSGO), has not taken a position on opportunistic salpingectomy. The response rate was 58% and 54% of responding institutions reported performing opportunistic salpingectomy.…”

“…The initiative started in 2010 in British Columbia changed practice there [ 5 ]. Significant increases in salpingectomy at the time of hysterectomy have been seen in the United States [ 6 7 8 ]. In Italy, 80% of surveyed physicians reported performing prophylactic salpingectomy [ 9 ].…”

“…Until that time national societies and individual physicians and patients will need to make recommendations and decisions without an evidence base of prospective studies. The study by Mikami et al [ 6 ] and statements by societies around the world indicate that many consider the potential benefit of opportunistic salpingectomy in reducing mortality from a most difficult disease greater than the risk.…”

Effect of salpingectomy on ovarian response to hyperstimulation during in vitro fertilization: does it really matter?

“…Meanwhile, considering the recommendations of many national societies on the opportunity to prevent ovarian cancers through the prophylactic removal of Fallopian tubes during surgeries for benign pathologies [3], and considering that also in those countries where the professional societies have not taken an official position the available evidence and recommendations from other countries have already changed [10][11][12][13], caution is required in reporting any indirect and not certain negative effects of salpingectomy.…”