Operative Outcomes of Opportunistic Bilateral Salpingectomy at the Time of Benign Hysterectomy in Low-Risk Premenopausal Women: A Systematic Review.

Opportunistic bilateral salpingectomy (OBS) is gaining momentum as a potential strategy for preventing epithelial ovarian cancer (EOC). OBS has been associated with a 40% to 65% decrease in the incidence of EOC when performed at the time of benign hysterectomy in patients at population-level risk for EOC. Current data suggest minimal disadvantage or "cost" to the patient and system from this practice in terms of estimated blood loss (EBL), operative time, length of hospital stay, ovarian reserve depletion, and complications attributable to OBS. These costs merit additional scrutiny in comparison with potential benefits before OBS can be adopted or recommended universally as a preventative strategy. This systematic review identifies 10 comparative studies (8 cohorts and 2 randomized controlled studies) ranging from 19 to 425 180 patients that cumulatively demonstrate a small to no increase in operative time and no additional EBL, hospital stay, or complications attributable to OBS at the time of benign hysterectomy. We anticipate that more widespread adoption of OBS will necessarily incorporate more difficult salpingectomies, thus potentially increasing the time, EBL, and complications associated with this practice in large studies. This consideration should be weighed into discussions of whether salpingectomy at the time of hysterectomy would ever be considered mandatory (or failure to perform OBS be considered negligent) and may have to be considered for fair reimbursement for any additional time and risk of this surgical step. Given the available evidence of benefit, further randomized controlled trials for salpingectomy versus no salpingectomy at the time of hysterectomy are unlikely to be feasible and may be unethical. Going forward, additional large prospective cohorts with historical control subjects will be valuable in assessing the additional costs of universal OBS at the time of benign hysterectomy.