Fisch Charlotte, Gelderblom Malou E, Hermens Rosella P M G, de Reuver Philip R, Nienhuijs Simon W, Somford Diederik M, de Hullu Joanne A, Piek Jurgen M J
Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of IQ Health, Radboud University Medical Centre, Nijmegen, The Netherlands.
BJS Open. 2024 Dec 30;9(1). doi: 10.1093/bjsopen/zrae161.
Ovarian cancer is the leading cause of death among gynaecological cancers. The identification of the fallopian tube epithelium as the origin of most ovarian cancers introduces a novel prevention strategy by removing the fallopian tubes during an already indicated abdominal surgery for another reason, also known as an opportunistic salpingectomy. This preventive opportunity is evidence based, recommended and established at the time of gynaecologic surgery in many countries worldwide. To expand interest among surgeons in performing a salpingectomy during non-gynaecological surgery, the aim of this review is to identify knowledge gaps during those surgeries.
A scoping review was performed following the PRISMA-Scoping Review (ScR) checklist. PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) database and Cochrane Library were systematically searched from inception to November 2024. Trial registers were searched for ongoing trials. All studies reporting original data on salpingectomy during non-gynaecological surgery were included. Outcomes were provided narratively.
Eighteen studies were identified reporting on the implementation, surgical feasibility, patients' perspectives, physicians' knowledge and cost-effectiveness of an opportunistic salpingectomy during non-gynaecological surgery. Population-level data indicate that an opportunistic salpingectomy is rarely performed in non-gynaecological surgeries. High success rates and no complications of an opportunistic salpingectomy were observed during bariatric surgery and cholecystectomies. However, performing an additional salpingectomy appeared more time-consuming. Patients had strong interest in information on and willingness to undergo opportunistic salpingectomy. Cost-effectiveness analysis encourages opportunistic salpingectomy use, as models show reduced ovarian cancer incidence and mortality rate while being cost-effective.
Opportunistic salpingectomy during non-gynaecologic surgery appears to be a promising method to prevent ovarian cancer. Implementing such a strategy will require education of multiple surgical disciplines, training and resolution of organizational issues.
卵巢癌是妇科癌症中导致死亡的主要原因。将输卵管上皮确定为大多数卵巢癌的起源，这引入了一种新的预防策略，即在因其他原因已经进行的腹部手术（也称为机会性输卵管切除术）期间切除输卵管。这种预防机会有循证依据，在全球许多国家的妇科手术中得到推荐和确立。为了提高外科医生在非妇科手术中进行输卵管切除术的兴趣，本综述的目的是确定这些手术过程中的知识空白。
按照PRISMA - 范围综述（ScR）清单进行范围综述。从数据库建立至2024年11月，对PubMed、Embase、科学引文索引、护理及相关健康文献累积索引（CINAHL）数据库和Cochrane图书馆进行系统检索。检索试验注册库以查找正在进行的试验。纳入所有报告非妇科手术期间输卵管切除术原始数据的研究。以叙述方式呈现结果。
共确定了18项研究，报告了非妇科手术期间机会性输卵管切除术的实施情况、手术可行性、患者观点、医生知识以及成本效益。人群层面的数据表明，机会性输卵管切除术在非妇科手术中很少进行。在减肥手术和胆囊切除术中观察到机会性输卵管切除术成功率高且无并发症。然而，额外进行输卵管切除术似乎更耗时。患者对机会性输卵管切除术的信息和接受意愿有浓厚兴趣。成本效益分析鼓励使用机会性输卵管切除术，因为模型显示其可降低卵巢癌发病率和死亡率，同时具有成本效益。
非妇科手术期间的机会性输卵管切除术似乎是预防卵巢癌的一种有前景的方法。实施这种策略需要对多个外科领域进行教育、培训并解决组织问题。
