Opportunistic Salpingectomy for the Primary Prevention of Ovarian Cancer

The case numbers for the main diagnoses or surgeries, performed individually or in combination according to OPS coding, were queried from the German Federal Statistical Office (Destatis, Special Evaluation of Diagnostic-Related Group [DRG] Statistics): appendectomies (5-470*), salpingectomies (5-661*), salpingo-oophorectomies (5-653*), sterilizations (5-663*; destruction and closure of the fallopian tubes), and hysterectomies ([5-682*; partial extirpation of the uterus] + [5-683*; total extirpation of the uterus]). The survey applies to all hospitals in Germany with DRG reimbursement according to Section 1 of the Hospital Remuneration Act and refers to discharged inpatients (including deaths and hospital day cases) without duplicates in the OPS 4-digit code. The identity of the patients, the side on which the salpingectomy was performed, and any given information about the option of OS were not recorded. Case numbers for the outpatient sector are currently not available (according to the KBV [Association of Statutory Health Insurance Physicians] on 4 May, 2022).

In 2020, 50 398 cases of salpingectomy were performed, about four times more compared to 2005 (with 12 286 cases) (Figure). The number of salpingectomies performed showed little change until 2011 (with 12 167 cases). However, there was an increase of at least 5000 salpingectomies per year from 2012 (19 475) to 2018 (54 382), mostly in combination with a hysterectomy (with 37 732 combined procedures in 2020). The number of inpatient procedures of sterilization using tubal ligation showed a moderate increase, from 6943 (2005) to 9243 (2020) (Figure). The number of cases of removal of the fallopian tubes and ovaries (salpingo-oophorectomy) remained stable over the period examined (2005: 40 355; 2020: 40 485), while the number of hysterectomies performed fell sharply (2005: 146 665; 2020: 83 174) (Figure). In 2020, more than half of the hysterectomies in women between the ages of 30 and 54 were performed in combination with a salpingectomy, and even more than two thirds in women in the 35� to 49-year-old age range (Table). Following menopause, however, the adnexa are usually completely removed (salpingo-oophorectomy) (Table). Two thirds (67%) of salpingectomies in 2020 were coded with principal diagnoses, representing a benign indication for hysterectomy, and only 11% with tubal disease. The number of cases according to frequency were: D25 (uterine leiomyoma): 21 383; N80 (endometriosis): 5039; N81 (female genital prolapse): 4101; N92 (excessive, frequent, or irregular menstruation): 3235; N83 (non-inflammatory disorders of ovary, fallopian tube, and broad ligament): 2069; N70 (salpingitis): 1871; O00 (extra-uterine pregnancy): 1686.

The development of the number of cases in the inpatient sector of the German health system proves that there is an increased implementation of OS in the context of hysterectomy for benign indications, despite the current lack of recommendation from specialist societies. In a survey of German gynecologists, which we conducted together with the North-East German Society for Gynecological Oncology (NOGGO e.V.) and the Ovary Commission of the Working Group for Gynecological Oncology (AGO e.V.), confirms the acceptance and frequent use of OS (manuscript forthcoming). Carrying out an OS could be favored by the increase in laparoscopic interventions with access to tubes (laparoscopic + laparoscope-assisted vaginal hysterectomies; 2005: 10%, 2020: 57%), with a decrease in purely transvaginal hysterectomies (2005: 50%; 2020: 21%) (German Federal Office of Statistics). From our point of view, an adjustment of the expert consensus recommendations in Germany and other countries is necessary in order to give the practicing physicians a secure basis for this procedure, which is now very frequently performed (for comparison: 49 697 appendectomies in 2020). We recommend an interdisciplinary agreement on a uniform approach to counseling, indication, and implementation of OS, as well as for the histopathological work-up for detecting precursor lesions of ovarian carcinoma. Existing data from clinical studies and routine documentation regarding the clinical benefits, risks, and the health-economic balance of OS should be evaluated and collected in a prospective national register in the future. Women seeking permanent contraception should be informed about the advantages and disadvantages of salpingectomy. Ingo B. Runnebaum, Angela Kather, Jalid Sehouli Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany (Runnebaum, Kather), [email protected] Department of Gynecology with Oncological Surgery, Charit�Universit�tsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany (Sehouli) Conflict of interest statement The authors declare that no conflict of interest exists. Manuscript received on 29 March 2022, revised version accepted on 12 May 2022 Translated from the original German by Veronica A. Raker, PhD. Cite this as: Runnebaum IB, Kather A, Sehouli J: Opportunistic salpingectomy for the primary prevention of ovarian cancer. Dtsch Arztebl Int 2022; 119: 846�7. DOI: 10.3238/arztebl.m2022.0232 | 1. | Zentrum f�r Krebsregisterdaten: Eierstockkrebs (Ovarialkarzinom). www.krebsdaten.de/Krebs/DE/Content/Krebsarten/Eierstockkrebs/eierstockkrebs_node.html (last accessed on 7 February 2022). | | 2. | Falconer H, Yin L, Gr�nberg H, Altman D: Ovarian cancer risk after salpingectomy: a nationwide population-based study. J Natl Cancer Inst 2015; 107(2). | | 3. | Kurman RJ, Shih IM: The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory. Am J Surg Pathol 2010; 34: 433�43. CrossRef MEDLINE PubMed Central | | 4. | Vorwergk J, Radosa MP, Nicolaus K, et al.: Prophylactic bilateral salpingectomy (PBS) to reduce ovarian cancer risk incorporated in standard premenopausal hysterectomy: complications and re-operation rate. J Cancer Res Clin Oncol 2014; 140: 859�65 CrossRef MEDLINE | | 5. | Ntoumanoglou-Schuiki A, Tomasch G, Laky R, Taumberger N, Bjelic-Radisic V, Tamussino K: Opportunistic prophylactic salpingectomy for prevention of ovarian cancer: what do national societies advise? Eur J Obstet Gynecol Reprod Biol 2018; 225: 110�2 CrossRef MEDLINE |