Abstract B20: Uptake and safety of bilateral salpingectomy for ovarian cancer prevention in the United States.
Authors: Hanley Gillian , McAlpine Jessica , Pearce Leigh 
Published: May 2016

Ovarian cancer is the leading cause of death due to gynecologic malignancy and the fifth most common cause of cancer deaths in developed countries. Recent evidence has indicated that the most common and lethal form of ovarian cancer originates in the distal fallopian tube, making surgical removal of the fallopian tube (bilateral salpingectomy) at the time of other gynecologic surgeries (particularly hysterectomy and tubal ligation) a potential ovarian cancer prevention strategy. We aimed to assess the uptake and perioperative safety of bilateral salpingectomy (BS) as an ovarian cancer risk-reduction strategy in the United States and to examine the factors associated with increased likelihood of getting a BS with benign gynecologic surgery.

The Nationwide Inpatient Sample was used to identify all women 15 years or older who underwent inpatient hysterectomy or tubal sterilization between 2008 and 2012. Weighted estimates of national trends were calculated and the number of procedures performed estimated. Safety was assessed by examining rates of blood transfusions, perioperative complications, post procedural infection and fever, and adjusted odds ratios were calculated comparing hysterectomy with salpingectomy with hysterectomy alone.

There was an increase in the uptake of hysterectomy with BS of 129% across the study period; however, this represented only 1.9% of total hysterectomies. There were only 233 salpingectomies for sterilization, thus no further comparisons were possible in this group. In the hysterectomy with BS women, there was no statistically significantly increased risk for blood transfusion (aOR, 0.89; 95%CI 0.79, 1.00) post-operative complications (aOR, 0.94; 95%CI 0.83, 1.07), post-operative infections (aOR, 1.44; 95%CI 0.97, 2.14) or fevers (aOR, 1.33; 1.00, 1.77) compared with women undergoing hysterectomy alone. Being younger, having more chronic conditions, being in a private, for profit hospital, indication for hysterectomy, and not being operated on in a small hospital were all associated with increased likelihood of getting a hysterectomy with BS compared to getting a hysterectomy alone.

Our results suggest that, despite some significant growth, relatively few patients were receiving BS in the United States between 2008 and 2012. Given that the Society for Gynecologic Oncology and the American College of Obstetrics and Gynecology published recommendations to discuss BS with patients undergoing hysterectomy or tubal ligation in 2013 and 2015 respectively, and that our data extends only to 2012 we expect that rates may have risen more dramatically following those recommendations. Despite not reaching statistical significance, the aORs for both post-operative infection and fever were suggestive of an increased risk in women undergoing hysterectomy with BS. We hypothesize this is related to indication for BS,including hydrosalpinx and pelvic inflammatory disease, but recommend further research.

Citation Format: Gillian Hanley, Jessica McAlpine, Leigh Pearce. Uptake and safety of bilateral salpingectomy for ovarian cancer prevention in the United States. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: Exploiting Vulnerabilities; Oct 17-20, 2015; Orlando, FL. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(2 Suppl):Abstract nr B20.