British Columbia was the first jurisdiction in the world to introduce opportunistic salpingectomy in 2010.[1] Opportunistic salpingectomy refers to the removal of the fallopian tubes during hysterectomy or instead of tubal ligation, while leaving the ovaries intact. It has proven to be an effective means to prevent ovarian cancer, particularly serous ovarian cancer.[2,3]

As there is no effective screening for ovarian cancer, it is often diagnosed at an advanced stage, making prevention key in reducing morbidity and mortality associated with ovarian cancer. High-grade serous cancer (HGSC) is the most common and aggressive subtype of ovarian cancer and mostly arises from the fallopian tube epithelium.[4] The risk of developing ovarian cancer in the general population is 1.4%;[5] however, this risk significantly increases in those with the germline mutations BRCA1 and BRCA2 (a cumulative risk of up to 75% and 34%, respectively).[6] Therefore, prophylactic bilateral salpingo-oopherectomy is recommended in this higher-risk patient population. However, to reduce the risk of ovarian cancer in the general population—where 80% of ovarian cancers develop—prophylactic removal of the ovaries is not advised, considering the risk of early iatrogenic menopause, coronary artery disease, osteoporosis, and mortality.[7] In women who have finished having children, removing the fallopian tubes provides an effective strategy to reduce HGSC risk without any hormonal consequences.

Gynecologists offer salpingectomy in patients undergoing pelvic surgeries such as hysterectomy or in place of tubal ligation as a sterilization method. Studies have shown no increased risk of complications such as bleeding,[8] ureteric or ovarian injury (oral communication from Dr Gillian Hanley, associate professor, UBC Faculty of Medicine, 8 September 2025), or conversion to open surgery[9] when opportunistic salpingectomy is added to the index surgery. In a recent study, Hanley and colleagues compared observed and expected cases of HGSC in patients undergoing opportunistic salpingectomy and demonstrated a significant reduction in ovarian cancer rates (0% versus 5.27%; 95% CI, 1.78-19.29).[3]

Considering that general surgeons commonly perform abdominal surgeries and the relative safety and ease of performing opportunistic salpingectomy, their involvement will allow for significantly more salpingectomies at the population level, contributing to an overall reduction in HGSC. Studies so far have supported opportunistic salpingectomy during laparoscopic cholecystectomy without increased complication rates, with an average additional operative time of 13 minutes.[10] Although in 30.5% cases, an additional port placement was required during laparoscopic cholecystectomy, this should not have significant consequences for patients or their surgical outcome. Opportunistic salpingectomy can also be safely and conveniently performed during other nongynecological pelvic operations, such as colon and rectal resections. Unpublished data from BC support performing opportunistic salpingectomy during colorectal surgery, with only 4 minutes of added operative time.

Despite the current trends and evidence, more widespread buy-in from general surgeons is needed. The somewhat slow uptake can be explained, in part, by issues with remuneration, added operative time, a surgeon’s comfort level to perform the procedure, and medicolegal concerns, particularly related to patient selection and appropriate consent. There has been excellent work done by British Columbia health care leaders Drs Gillian Hanley, Heather Stuart, and Scott Cowie to encourage and support general surgeons in performing opportunistic salpingectomy. These measures include creating a new billing code for general surgeons performing opportunistic salpingectomy; patient pamphlets in 13 languages to help with patient education; and patient videos explaining the procedure, including its indications and benefits, to facilitate informed consent. There is also a dedicated group of gynecologists around BC who are available to help support general surgeons in performing opportunistic salpingectomy. On Vancouver Island, we have been able to secure funding to raise awareness and run multidisciplinary education sessions to encourage participation from general surgeons in opportunistic salpingectomy.

With increased awareness, women in BC will have the opportunity to discuss opportunistic salpingectomy with their primary care and specialist physicians, allowing for a more widespread practice of this procedure across the province. Recent data from the United States suggest that taking advantage of all surgical opportunities to offer patients opportunistic salpingectomy could prevent up to 25% of ovarian cancers.[11] No new treatments have provided such a significant improvement in survival for ovarian cancer patients in the past 50 years. Therefore, the potential to reduce the morbidity and mortality from ovarian cancer by expanding opportunistic salpingectomy to general surgery is not trivial. In an elective setting, opportunistic salpingectomy is a low-risk, relatively simple procedure that can be carried out with little to no extra resources required intra-operatively, and I strongly encourage general surgeons to incorporate opportunistic salpingectomy into their practice.
—Sepehr Khorasani, MD, MSc, FRCSC

Acknowledgments

I would like to thank Drs Gillian Hanley and Caitlin Dunne for their expertise and contributions to this editorial.

hidden

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

1.    Ntoumanoglou-Schuiki A, Tomasch G, Laky R, et al. Opportunistic prophylactic salpingectomy for prevention of ovarian cancer: What do national societies advise? Eur J Obstet Gynecol Reprod Biol 2018;225:110-112. https://doi.org/10.1016/j.ejogrb.2018.03.043.

2.    McAlpine JN, Hanley GE, Woo MM, et al. Opportunistic salpingectomy: Uptake, risks, and complications of a regional initiative for ovarian cancer prevention. Am J Obstet Gynecol 2014;210:471.e1-11. https://doi.org/10.1016/j.ajog.2014.01.003.

3.    Hanley GE, Pearce CL, Talhouk A, et al. Outcomes from opportunistic salpingectomy for ovarian cancer prevention. JAMA Netw Open 2022;5:e2147343. https://doi.org/10.1001/jamanetworkopen.2021.47343.

4.    Tone AA, Salvador S, Finlayson SJ, et al. The role of the fallopian tube in ovarian cancer. Clin Adv Hematol Oncol 2012;10:296-306.

5.    Pearce CL, Stram DO, Ness RB, et al. Population distribution of lifetime risk of ovarian cancer in the United States. Cancer Epidemiol Biomarkers Prev 2015;24:671-676. https://doi.org/10.1158/1055-9965.EPI-14-1128.

6.    Mavaddat N, Peock S, Frost D, et al. Cancer risks for BRCA1 and BRCA2 mutation carriers: Results from prospective analysis of EMBRACE. J Natl Cancer Inst 2013;105:812-822. https://doi.org/10.1093/jnci/djt095.

7.    Eleje GU, Eke AC, Ezebialu IU, et al. Risk-reducing bilateral salpingo-oophorectomy in women with BRCA1 or BRCA2 mutations. Cochrane Database Syst Rev 2018;8:CD012464. https://doi.org/10.1002/14651858.CD012464.pub2.

8.    Hanley GE, McAlpine JN, Pearce CL, Miller D. The performance and safety of bilateral salpingectomy for ovarian cancer prevention in the United States. Am J Obstet Gynecol 2017;216:270.e1-270.e9. https://doi.org/10.1016/j.ajog.2016.10.035.

9.    van Lieshout LAM, Steenbeek MP, De Hullu JA, et al. Hysterectomy with opportunistic salpingectomy versus hysterectomy alone. Cochrane Database Syst Rev 2019;8:CD012858. https://doi.org/10.1002/14651858.CD012858.pub2.

10.    Tomasch G, Lemmerer M, Oswald S, et al. Prophylactic salpingectomy for prevention of ovarian cancer at the time of elective laparoscopic cholecystectomy. Br J Surg 2020;107:519-524. https://doi.org/10.1002/bjs.11419.

11.    Moufarrij S, Hazimeh D, Rockwell T, et al. Gauging the magnitude of missed opportunity for ovarian cancer prevention. JAMA Surg 2025:e252810. https://doi.org/10.1001/jamasurg.2025.2810.