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Mind Matters
Vol. 20 No 3 | Spring 2018
Women's Health -> Journal Club
Salpingectomy at hysterectomy
Dr Brett Daniels
BSc, PhD, MBBS, FRANZCOG

A significant proportion of ovarian cancer originates in the fallopian tubes. A 2016 meta-analysis concluded that removal of the fallopian tubes at hysterectomy or sterilisation in the general non-high-risk population had a significant reduction in the occurrence of ovarian cancer (OR=0.51, 95% CI 0.35-0.75).1 A recent Australian study reported on the change in trends of route of hysterectomy and removal of adnexae from 2001–2015.2 The overall rate of hysterectomy fell significantly across these years from 54.7 to 40.7 per 10,000 per year (p<0.005). There was a decrease in the number of hysterectomies performed by the abdominal and vaginal routes, while the rate of laparoscopic hysterectomy rose by 153 per cent over the study period. The rate of adnexal removal at hysterectomy for benign reasons increased in both the younger age group (35–54 years old) from 31 per cent to 65 per cent (p<0.005), and in the older age group (over 55 years old) from 44 per cent to 58 per cent (p<0.005). This increase has occurred almost entirely after 2011. There was no significant increase in the rate of adnexal removal from 2001–2011 in either the younger or older age groups.3 One possible consequence of hysterectomy is decrease of ovarian reserve, despite preservation of the ovaries. A recent small study compared the decrease in anti-Müllerian hormone (AMH) levels pre and post-hysterectomy in women who were randomised to removal or preservation of their fallopian tubes. In both groups, there was a significant decrease in AMH three months after hysterectomy. However, there was no difference in the change, comparing women who had their tubes removed or preserved.4

References

  1. Yoon S, Kim S, Shim S, et al. Bilateral salpingectomy can reduce the risk of ovarian cancer in the general population: A meta-analysis. Eur J Cancer 2016 Mar; 55:38-46.
  2. Cure N, Robson S. Changes in hysterectomy route and adnexal removal for benign disease in Australia 2001–2015: a national population-based study. Minimally Invasive Surgery 2018; 2018:5828071.
  3. Cure N, Robson S. Changes in hysterectomy route and adnexal removal for benign disease in Australia 2001–2015: a national population-based study. Minimally Invasive Surgery 2018; 2018:5828071.
  4. Asgari Z, Tehranian A, Rouholamin S, et al. Comparing surgical outcome and ovarian reserve after laparoscopic hysterectomy between two methods of with and without prophylactic bilateral salpingectomy: a randomized controlled trial. J Can Res Ther 2018; 14:543-8.

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