Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York.
JAMA Surg. 2023 Nov 1;158(11):1204-1211. doi: 10.1001/jamasurg.2023.4164.
Most ovarian cancers originate in the fimbriated end of the fallopian tube. This has led to the hypothesis that surgical resection of the fallopian tubes at the time of gynecologic and nongynecologic surgical procedures-referred to as an opportunistic salpingectomy-may prevent the development of epithelial ovarian cancer for women at an average risk of developing the disease.
To compile a comprehensive, state-of-the-science review examining the current landscape of performing bilateral salpingectomy for ovarian cancer prevention.
A systematic review of the literature was performed on March 4, 2022, to identify studies examining salpingectomy for ovarian cancer prevention. This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement. Four databases were selected: PubMed via the National Library of Medicine's PubMed.gov, Embase via Elsevier's Embase.com, Cochrane Central Register of Controlled Trials (CENTRAL) via Wiley's Cochrane Library, and Northern Light Life Sciences Conference Abstracts via Ovid. A total of 20 gray literature sources, including 1 database, 2 registers, 1 repository, 1 index, 1 archive, 1 preprint server, 1 agency, and 12 organizations, were also searched.
The initial search produced 1089 results; a total of 158 publications were included in the final review. Salpingectomy has been associated with ovarian cancer risk reduction of approximately 80%. Studies have demonstrated that salpingectomy was safe, cost-effective, and was not associated with an earlier age of menopause onset. With widespread implementation, salpingectomy has the potential to reduce ovarian cancer mortality in the US by an estimated 15%. Both physician and patient awareness regarding the adnexa as the origin for most ovarian cancers, as well as the existence of salpingectomy and its potential benefits in reducing ovarian cancer risk, has increased during the past decade. Raising awareness and developing effective implementation strategies are essential.
The results of this systematic review suggest that bilateral salpingectomy for ovarian cancer prevention was safe and feasible and has the potential to be a cost-effective and cost-saving strategy across the population. Prospective studies to demonstrate long-term survival outcomes and feasibility in nongynecologic surgical procedures are warranted.
大多数卵巢癌起源于输卵管的伞端。这导致了这样一种假设，即在妇科和非妇科手术时切除输卵管——即所谓的机会性输卵管切除术——可能会预防平均患病风险的女性发生上皮性卵巢癌。
编纂一份全面的、基于科学的综述，审查目前为预防卵巢癌而行双侧输卵管切除术的情况。
于 2022 年 3 月 4 日对文献进行了系统综述，以确定研究输卵管切除术预防卵巢癌的研究。本综述是根据系统评价和荟萃分析的首选报告项目 (PRISMA) 2020 声明进行的。选择了四个数据库：美国国家医学图书馆的 PubMed.gov 上的 PubMed、Elsevier 的 Embase.com 上的 Embase、Wiley 的 Cochrane 图书馆上的 Cochrane 中央对照试验注册中心 (CENTRAL)，以及 Ovid 上的 Northern Light 生命科学会议摘要。还搜索了 20 个灰色文献来源，包括 1 个数据库、2 个登记处、1 个存储库、1 个索引、1 个档案、1 个预印本服务器、1 个机构和 12 个组织。
最初的搜索产生了 1089 个结果；共有 158 篇出版物被纳入最终综述。输卵管切除术与卵巢癌风险降低约 80%相关。研究表明，输卵管切除术是安全的、具有成本效益的，并且与绝经年龄提前无关。如果广泛实施，输卵管切除术有可能使美国的卵巢癌死亡率降低约 15%。在过去的十年中，医生和患者对附件是大多数卵巢癌的起源的认识，以及输卵管切除术的存在及其在降低卵巢癌风险方面的潜在益处，都有所增加。提高认识和制定有效的实施策略至关重要。
本系统综述的结果表明，双侧输卵管切除术预防卵巢癌是安全可行的，有可能成为整个人群具有成本效益和节省成本的策略。需要进行前瞻性研究以证明长期生存结果，并在非妇科手术中证明其可行性。
