Netherlands: A growing body of evidence indicates that many cases of tubo-ovarian carcinoma originate in the fallopian tubes rather than the ovaries. This shift in understanding has brought renewed attention to preventive surgical strategies that can be integrated into routine care with minimal added risk.
In a Special Communication published in JAMA, the European Society of Gynaecological Oncology (ESGO) has released evidence-based consensus statements supporting opportunistic salpingectomy as a cancer prevention strategy. The recommendations were developed by an international expert group led by Jurgen M. Piek from the Department of Obstetrics and Gynecology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands, and aim to guide clinicians on the safe and effective use of this procedure in routine surgical practice.
Opportunistic salpingectomy involves the removal of fallopian tubes during gynecological surgery for benign conditions or during selected nongynecological pelvic or abdominal procedures in women who have completed childbearing. This approach is grounded in growing evidence that the fallopian tube epithelium is a key site of origin for high-grade serous tubo-ovarian carcinoma, the most common and lethal subtype of ovarian cancer.
To formulate these recommendations, ESGO convened a multidisciplinary working group of 14 members, including a patient representative. The group conducted a comprehensive review of English-language studies published between January 2000 and March 2025 using the MEDLINE database. Of the 230 studies identified, 129 were included for consensus development. Draft statements were refined through structured discussions and both anonymous and non-anonymous voting, with final consensus achieved for 18 statements, each receiving more than 75% agreement. The strength of recommendations ranged from grades B to D, with levels of evidence spanning II to V.
The consensus statements highlight several key points for clinical practice:
- All eligible women should be counseled about opportunistic salpingectomy as a preventive option.
- Opportunistic salpingectomy should be considered for women undergoing gynecological pelvic surgery to reduce future tubo-ovarian carcinoma risk.
- Where feasible, it may also be considered during selected nongynecological pelvic or abdominal surgeries.
- Adding salpingectomy does not impair short-term ovarian function and does not appear to affect age at menopause or menopausal symptoms.
- Long-term data on ovarian reserve and menopausal timing remain limited and should be discussed during counseling.
- Age alone should not be used as a reason to withhold opportunistic salpingectomy.
- The procedure generally adds minimal operative time and does not significantly increase perioperative complication rates.
- Opportunistic salpingectomy is feasible across different surgical approaches, although severe adhesions or other risk factors may limit its use in select cases.
- No additional or specialized postoperative follow-up is required beyond standard surgical care.
- Enrollment of patients into prospective studies is encouraged to strengthen long-term evidence.
The expert group emphasized the importance of individualized, shared decision-making. Counseling should clearly address potential benefits, current uncertainties regarding long-term outcomes, and the irreversible loss of fertility associated with the procedure.
The authors acknowledged several limitations in the available evidence, including reliance on observational data, lack of economic evaluations, and limited representation of younger women, postmenopausal women, and patients undergoing nongynecological surgeries. Most studies were also conducted in high- and middle-income countries, which may affect global applicability.
Despite these gaps, ESGO concluded that opportunistic salpingectomy represents a low-risk, feasible, and potentially high-impact strategy for reducing tubo-ovarian carcinoma risk. The society recommends its routine consideration during gynecological surgeries and, when appropriate, selected nongynecological procedures, reinforcing its role as an important preventive intervention in contemporary women’s health care.
Reference:
Piek JM, Schauwaert J, Ellis LB, et al. Opportunistic Salpingectomy for Prevention of Tubo-Ovarian Carcinoma: The European Society of Gynaecological Oncology Consensus Statements. JAMA. Published online February 02, 2026. doi:10.1001/jama.2025.24510
