Most Patients With HGSOC Missed Chances for Opportunistic Salpingectomy During Pre-Diagnosis Surgeries

Nearly 60% of patients with high-grade serous ovarian cancer (HGSOC) had a qualifying index surgery during which an opportunistic salpingectomy could have been performed, often an average of 3 decades before their diagnosis, according to a study published in Gynecologic Oncology.1

Over half of patients with high-grade serous ovarian cancer (HGSOC) had prior abdominal or pelvic surgeries, often decades before diagnosis, where opportunistic salpingectomy could have reduced risk. | Image Credit: Georgii - stock.adobe.com

Evaluating Missed Opportunistic Salpingectomy Chances in Patients With HGSOC

Among histologic subtypes of epithelial ovarian cancer (EOC), HGSOC accounts for roughly 75% of new diagnoses and is responsible for most ovarian cancer-related deaths due to its prevalence and aggressive nature.2 Over the past 25 years, evidence has shown that HGSOC originates in the fimbriae of the fallopian tube rather than the ovarian surface epithelium. As a result, opportunistic salpingectomy has become the recommended standard of care during benign gynecologic surgeries in women who have completed childbearing or are undergoing tubal sterilization.1

Prior research has shown that opportunistic salpingectomy carries minimal perioperative risk, few surgical complications, no earlier onset of menopause, and is cost-effective for ovarian cancer prevention. To broaden its preventive potential among women at average ovarian cancer risk, the procedure is now being considered during nongynecologic abdominal or pelvic surgeries. Because of this, the researchers conducted a retrospective cohort study to determine how many patients later diagnosed with HGSOC had previously undergone abdominal or pelvic surgeries where opportunistic salpingectomy could have been offered.

Using Mayo Clinic’s Outcomes in EOC research database, the researchers identified patients diagnosed with HGSOC between 2014 and 2021. Extracted data included demographics, prior abdominal and pelvic surgeries, and the specialty performing the index procedure. Eligible surgeries occurred at least 6 months before diagnosis, were non-emergent, and were performed after completion of childbearing.

Pre-Diagnosis Surgical Patterns Highlight Prevention Gaps

The researchers identified 605 eligible patients, most of whom were White (95.2%) with a median age of 65.0 (IQR, 58.0-71.0) years at diagnosis. Among these patients, 8.8% were diagnosed at the International Federation of Gynecology and Obstetrics stage I or II, 90.9% were diagnosed at stage III or IV, while 0.3% had an unknown stage.

Overall, 56.5% (n = 342) had at least one qualifying abdominal or pelvic surgery, representing 500 unique surgical events. In contrast, 43.5% (n = 263) had none. Among those with an index surgery, the median age at the first procedure was 34.4 (IQR, 28.7-41.6) years, and the average interval between the first qualifying surgery and HGSOC diagnosis was 28 years.

Seven surgical subspecialties performed the 500 index procedures. Gynecology accounted for the largest proportion of surgeries (59.4%), followed by general and trauma surgery (35.2%), with the remaining subspecialties (bariatric, colorectal, transplant, urological, and hepatobiliary) performing 5.4%.

Gynecology alone performed 297 index surgeries, most commonly tubal ligation (33.0%; n = 98), hysterectomy (33.0%; n = 98), cesarean section (24.6%; n = 73), and ovarian cystectomy (5.1%; n = 15). General and trauma surgery accounted for 176 index surgeries, with the most frequent being cholecystectomy (53.4%; n = 94), appendectomy (27.8%; n = 49), and hernia repair (11.9%; n = 21).

The Path Forward for Ovarian Cancer Prevention

The researchers concluded by acknowledging their limitations, including the study population's limited racial and ethnic diversity, which may affect the generalizability of their findings. Still, they emphasized the implications of their findings for ovarian cancer prevention efforts.

“…opportunities exist to expand the potential of opportunistic salpingectomy across non-gynecologic surgical specialties,” the authors concluded. “While long-term data on the true impact of opportunistic salpingectomy will take time to accumulate, we can begin paving the way toward what is anticipated to be a dramatic improvement in ovarian cancer-associated mortality by broadening the surgical opportunities during which patients are counseled and offered opportunistic salpingectomy.”

References

1. Tischer KM, Islam NS, McGree ME, et al. Quantifying opportunities to reduce high grade serous ovarian cancer via opportunistic salpingectomy. Gynecol Oncol. Published online November 5, 2025. doi:10.1016/j.ygyno.2025.10.028
2. Ovarian cancer. Ovarian Cancer Research Alliance. Accessed November 30, 2025. https://ocrahope.org/for-patients/gynecologic-cancers/ovarian-cancer/