학술논문

Efficacy of salpingectomy at hysterectomy to reduce the risk of epithelial ovarian cancer: a systematic review.
Document Type
Journal Article
Source
BJOG: An International Journal of Obstetrics & Gynaecology. May2017, Vol. 124 Issue 6, p880-889. 10p. 1 Diagram, 3 Charts.
Subject
*OVARIAN epithelial cancer
*SALPINGECTOMY
*HYSTERECTOMY
*SURGICAL complications
*EVIDENCE-based medicine
*CANCER treatment
Language
ISSN
1470-0328
Abstract
Background: It has been argued that salpingectomy would reduce the risk of epithelial ovarian cancer (EOC), based on the theory of the tube being the site of origin.Objectives: To conduct a systematic review of 'salpingectomy' associated with ovarian cancer risk and 'salpingectomy with concomitant hysterectomy' on outcomes of complications including endocrine function.Search Strategy: A comprehensive search was conducted in PubMed, Embase, and the Cochrane library.Selection Criteria: Original studies and systematic reviews were eligible.Data Collection and Analysis: Each article was quality assessed. Data were extracted and, when possible, pooled in meta-analyses. The certainty of evidence across studies was evaluated using GRADE.Main Results: Of 844 articles found, 11 were included. No study evaluated risk reduction for EOC after salpingectomy in conjunction with hysterectomy. Two retrospective studies reported a reduced ovarian cancer risk after indicated salpingectomy, compared with no surgery: adjusted hazard ratio 0.65 (95% confidence interval, 95% CI 0.52-0.81) and adjusted odds ratio 0.58 (95% CI 0.36-0.95). Complications did not differ between groups with or without salpingectomy, but were non-systematically reported. Ovarian endocrine function, measured with surrogate outcomes, did not differ at short-term follow-up in randomised or observational studies. The certainty of evidence was very low or low for all outcomes.Conclusions: There is currently insufficient evidence to state that opportunistic salpingectomy reduces the risk of EOC. The impact on long-term endocrine function is unknown. The heterogeneity in results and identified knowledge gaps stress the need for a prospective trial.Tweetable Abstract: Insufficient evidence for prophylactic removal of the fallopian tubes for risk reduction of ovarian cancer. [ABSTRACT FROM AUTHOR]