The American College of Obstetricians and Gynecologists has strengthened its guidance on opportunistic bilateral salpingectomy (removal of both fallopian tubes during another planned operation) to reduce the risk of epithelial ovarian cancer.<\/p>\n
The updated Clinical Practice Update reflects growing evidence that many high-grade serous ovarian cancers begin in the fallopian tubes, particularly in the fimbrial region, before involving the ovaries. It updates ACOG\u2019s 2019 Committee Opinion and applies mainly to patients at average population risk, not to those with known high-risk genetic syndromes, who require separate risk-reduction guidance.<\/p>\n
The update strengthens four practical recommendations:<\/p>\n
Bilateral salpingectomy should routinely be performed during hysterectomy when clinically feasible.<\/p>\n
It should be recommended during nonhysterectomy gynecologic surgery that enters the peritoneal cavity when the patient does not desire future fertility.<\/p>\n
Complete bilateral salpingectomy is preferred over tubal ligation or partial salpingectomy for permanent contraception after shared decision-making.<\/p>\n
Gynecologists should support other surgical specialists in offering salpingectomy during appropriate nongynecologic abdominal or pelvic surgery.<\/p>\n
The change is not a recommendation that every patient undergo a separate operation. Rather, it emphasizes using an already planned operation as an opportunity to reduce future ovarian-cancer risk without removing the ovaries.<\/p>\n
The traditional term \u201covarian cancer\u201d includes several biologically different diseases. High-grade serous carcinoma\u2014the most common and lethal epithelial subtype\u2014often appears to originate in the distal fallopian tube. Endometrioid and clear-cell cancers may also be influenced by cells or tissue passing through the tubes into the pelvis.<\/p>\n
Removing both tubes may therefore reduce the chance that these precursor or initiating lesions develop or spread. Tubal ligation can provide some protection, particularly against certain endometrioid and clear-cell cancers, but usually leaves the fimbrial ends of the tubes in place. A complete salpingectomy is consequently expected to provide greater risk reduction for high-grade serous carcinoma.<\/p>\n
A 2016 meta-analysis found approximately a 49% lower odds of ovarian cancer after salpingectomy, and a later meta-analysis reported a similar association. More recent cohort data have suggested an even greater reduction in serous ovarian cancer in some populations, including a 2026 British Columbia study reporting a hazard ratio of 0.22 compared with comparator surgery.<\/p>\n
These findings are encouraging, but they come largely from observational research. They demonstrate an association and support the biological rationale for salpingectomy; they do not mean that the procedure eliminates ovarian-cancer risk.<\/p>\n
Some epithelial ovarian cancers may arise from the ovary, peritoneum, or other pathways that salpingectomy cannot prevent. Patients should therefore be told that the procedure reduces risk but does not guarantee prevention.<\/p>\n
Adding salpingectomy to an already indicated pelvic operation may modestly increase operative time, often by approximately 12\u201316 minutes. Available studies have not shown a significant increase in short-term surgical or perioperative complications. Studies to date also have not shown a clinically important short-term adverse effect on ovarian function.<\/p>\n
The ovaries are left in place, so salpingectomy is not intended to cause immediate surgical menopause. Nevertheless, the fallopian tubes and ovaries share part of their blood supply, and long-term effects on ovarian function and age at menopause remain incompletely established.<\/p>\n
For that reason, patients should receive balanced counseling rather than being told that long-term effects are definitively absent.<\/p>\n
For patients who are certain they do not want a future pregnancy, ACOG now identifies complete bilateral salpingectomy as the preferred tubal procedure.<\/p>\n
Compared with tubal occlusion or partial salpingectomy, it offers:<\/p>\n
Permanent contraception.<\/p>\n
Greater potential reduction in epithelial ovarian-cancer risk.<\/p>\n
Lower risk of ectopic pregnancy if pregnancy nevertheless occurs.<\/p>\n
Similar short-term perioperative outcomes in available studies.<\/p>\n
However, salpingectomy is irreversible and should be discussed alongside long-acting reversible contraception and vasectomy where appropriate. The decision must reflect the patient\u2019s reproductive goals, values, and willingness to accept permanent loss of tubal fertility.<\/p>\n
After vaginal birth or cesarean delivery, technical feasibility, time, staffing, safety, and access may affect whether complete salpingectomy can be performed. Partial procedures may still be considered when complete removal is unsafe, technically impossible, or declined after counseling.<\/p>\n
The guidance does not recommend:<\/p>\n
Removing the ovaries from average-risk patients solely to prevent ovarian cancer.<\/p>\n
Performing salpingectomy during an emergency operation without appropriate counseling.<\/p>\n
Changing a surgical route automatically when doing so would increase patient risk.<\/p>\n
Treating salpingectomy as a guarantee against ovarian cancer.<\/p>\n
Performing standalone salpingectomy routinely in every average-risk patient who has completed childbearing.<\/p>\n
Applying this guidance instead of specialized recommendations for patients with BRCA1, BRCA2, or other hereditary cancer risk.<\/p>\n
ACOG states that standalone salpingectomy solely for cancer prevention may be considered in selected average-risk patients, but more research is needed before it can be recommended routinely. The appropriate age and timing of such a procedure also remain uncertain.<\/p>\n