Data to Support a Widely Accepted Practice in Cancer Prevention

Current research indicates that the majority of ovarian cancers are serous epithelial in histology, which commonly originates in the fallopian tube as serous tubal intra-epithelial carcinoma. Findings from previous studies demonstrates an observed upward trend in Opportunistic salpingectomy (OS) at the time of hysterectomies - most notably since the practice was supported by the Society of Gynecologic Oncology of Canada in 2011.5 In 2013, the Society of Gynecologic Oncology published a consensus statement on women who are at average risk for ovarian cancer should be counseled regarding the option of salpingectomy at the time of hysterectomy or other pelvic surgeries as an alternative to tubal ligation. Public health campaigns and research evaluating the acceptability, safety, and cost-effectiveness of OS has been reported, without finding an increased risk in adverse events or complications during the post-operative period. After Institutional Review Board review and exempt determination, we performed a retrospective chart review for all robotic sacrocolpopexies performed with and without salpingectomies using the robot da Vinci Xi system from January 1, 2014 to March 1, 2022. Variables of interest include operation duration, length of hospital stay, readmission within 31 days, estimated blood loss (EBL), number and size of incisions, and narcotic use during hospitalization. Additional procedures performed at the time of operation were collected as potential confounding variables. For this study, two cohorts were created: (1) Patients who underwent a bilateral salpingectomy at time of colpopexy (SC-S) and (2) Patients who underwent colpopexy only (SC). Comparisons were performed with chi-square analysis for discrete variables and group t-tests for continuous level data. Narcotics administered during the immediate post-operative period until discharge was collected for each patient and converted to MME via multiplying the administered dose by the CDC established evidence-based conversion factor. Analysis of covariance (ANCOVA) as well as logistic regression was used to control for confounding variables, including the additional procedures patients had during their operation. An omnibus p-value of 0.05 was used to determine statistical significance for all tests. Narcotic use post-operation was significantly different between groups. As this study spanned over seven years, from 2014-2022, the opioid epidemic and its effect on provider practices may play a part in these findings. When analyzed by date of operation as well as between procedures, a decrease in the MME prescribed was found over time. Incision length differences can be attributed to the various provider techniques associated with hysterectomy prior to sacrocolpopexy: supracervical versus vaginal. This study highlights the importance of patient education and counseling on cancer prevention when scheduling a gynecologic procedure to improve compliance with risk-reducing clinical strategies. Future research should include multi-center large prospective cohort studies with historical control subjects to assess the cost and other potential complications of OS at the time of sacrocolpopexy.