Opportunistic Salpingectomy in Patients with High-Grade Serous Ovarian Carcinoma
January 1, 2026
By Alexandra Morell, MD
Synopsis: Of 650 patients diagnosed with high-grade serous ovarian cancer between 2014 and 2021, 56.5% underwent a prior abdominal or pelvic surgery with opportunity to undergo risk-reducing opportunistic salpingectomy with a median time between ovarian cancer diagnosis and prior surgery of 30.0 years (interquartile range, 19.4 to 37.7 years).
Source: Tischer KM, Islam NS, McGree ME, et al. Quantifying opportunities to reduce high grade serous ovarian cancer via opportunistic salpingectomy. Gynecol Oncol. 2025;203:165-170.
Ovarian cancer is the most lethal of all gynecologic malignancies.1 Approximately 90% of ovarian cancers are epithelial ovarian cancers, with high-grade serous carcinoma representing the predominant histologic subtype. Growing evidence indicates that these tumors likely originate from the tubal-peritoneal junction of the fallopian tube and then seed the ovary, as opposed to originating directly from the ovary.2 This paradigm shift has underscored the potential of opportunistic salpingectomy, or removal of both fallopian tubes during surgery performed for an alternative indication, as a strategy for decreasing the risk of ovarian cancer in women who have completed childbearing.
This was a retrospective cohort study conducted at a single institution over a seven-year period (2014-2021) that aimed to determine the proportion of patients with high-grade serous ovarian carcinoma (HGSOC) who previously had undergone abdominal or pelvic surgery and, thus, might have been candidates for opportunistic salpingectomy before their cancer diagnosis. Electronic medical records were reviewed for all patients diagnosed with HGSOC during the study period, with particular attention given to prior surgical history and any surgeries during which opportunistic salpingectomy could reasonably have been performed (termed index surgeries). Eligible index surgeries included non-emergent abdominal or pelvic surgeries performed at least six months prior to cancer diagnosis and after completion of childbearing (assumed for patients older than 45 years of age or if the patient had a prior sterilization procedure). Descriptive statistics were used to describe the results.
A total of 605 patients met inclusion criteria. The median age of HGSOC diagnosis was 64.2 years. A majority of patients identified their race as white (95.2%, n = 576) and ethnicity as non-Hispanic or Latino (95.0%, n = 575). Most patients were advanced stage (International Federation of Gynecology and Obstetrics [FIGO] stage III or IV) at diagnosis (90.9%, n = 550). More than half of patients (56.5%, n = 342) underwent an index surgery that met criteria as a potential opportunistic salpingectomy opportunity prior to diagnosis.
A total of 500 index surgeries were identified from seven surgical specialties. The largest proportion of index surgeries were performed by gynecology (59.4%), with tubal ligation as the most common procedure (33%). General surgery/trauma performed 35.2%, with the most common procedure being cholecystectomy (53%). The remaining 5.4% of index surgeries were performed by bariatric surgery, colorectal surgery, transplant surgery, urological surgery, and hepatobiliary surgery combined. The median age at first eligible index surgery was 34.4 years. The median time between index surgery and HGSOC diagnosis was 30.0 years (interquartile range, 19.4 to 37.7 years).
Most patients with HGOSC underwent genetic testing for hereditary breast and ovarian cancer (82%, n = 496). Of those who underwent a prior index surgery that was identified as an opportunity for opportunistic salpingectomy, 82.5% underwent genetic testing (n = 282/342). Of those tested, 76% had negative genetic testing. Therefore, most patients with prior surgical opportunities were negative for a hereditary cancer mutation, indicating that opportunistic salpingectomy at the time of prior surgery may have represented their only realistic chance for risk-reduction surgery.
Commentary
The lifetime incidence of ovarian cancer in the United States is 1.3%, making it the second most common gynecologic malignancy.1 Most patients with ovarian cancer are diagnosed with advanced stage disease, which is attributed to vague symptoms, such as bloating, early satiety, and abdominal discomfort; the absence of effective screening modalities; and rapid dissemination within the peritoneal cavity early in the disease course.3 Despite therapeutic advancements over the past three decades, outcomes remain poor: Five-year survival is approximately 41% for stage III and 20% for stage IV epithelial ovarian cancer.
Both the American College of Obstetricians and Gynecologists (ACOG) and the Society of Gynecologic Oncology (SGO) advise against routine ovarian cancer screening in individuals at average risk.4 This recommendation reflects evidence that screening with pelvic ultrasounds or tumor markers (commonly CA-125 levels) for detection of early ovarian cancer does not improve survival but is associated with false-positive results and may lead to unnecessary invasive procedures. However, ACOG acknowledges that opportunistic salpingectomy performed during other abdominal or pelvic surgeries is safe, adds minimal surgical time, and does not increase perioperative complications.5 Therefore, ACOG currently recommends a risk-benefit conversation about performing salpingectomy for ovarian cancer risk reduction at the time of pelvic surgery for an alternative indication.
This retrospective study of 605 individuals diagnosed with HGSOC demonstrated that more than half of women had undergone a prior abdominal or pelvic surgery that represented an opportunity to perform an opportunistic salpingectomy for risk-reduction of ovarian cancer. Notably, many of these procedures occurred decades before the eventual ovarian cancer diagnosis. Given the lack of effective screening tools and persistently poor five-year survival rates for patients with advanced stage disease, prevention of disease remains an important topic of consideration.
In particular, this study highlights missed opportunities for risk reduction and the importance of collaboration across surgical specialties as a method for expanding opportunistic salpingectomies as a prevention strategy. Specifically, a multidisciplinary approach to surgical care is essential for maximizing opportunities. By educating other surgical specialties about the evidence supporting opportunistic salpingectomy for ovarian cancer risk reduction, gynecology teams can be integrated into the perioperative planning process to facilitate gynecologic surgeons being present at the time of abdominal surgeries performed by other specialties so that risk-reducing surgery can be accomplished. Although this will require additional preoperative planning and coordination, this approach could help decrease missed opportunities.
Alexandra Morell, MD, is Adjunct Instructor, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY.
References
1. Reid BM, Permuth JB, Sellers TA. Epidemiology of ovarian cancer: A review. Cancer Biol Med. 2017;14(1):9-32.
2. Popat V, Han E. From fallopian tube to ovarian cancer: Understanding the evaluation and management of serous tubal intraepithelial carcinoma lesions. Curr Treat Options Oncol. 2025;26(10):910-919.
3. Torre LA, Trabert B, DeSantis CE, et al. Ovarian cancer statistics, 2018. CA Cancer J Clin. 2018;68(4):284-296.
4. [No authors listed]. Committee Opinion No. 716: The role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer in women at average risk. Obstet Gynecol. 2017;130(3):e146-e149.
5. [No authors listed]. ACOG Committee Opinion No. 774: Opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention. Obstet Gynecol. 2019;133(4):e279-e284.