Brief description of patient problem/setting (summarize the case very briefly)

31 y/o G7P7 Postpartum day one via Non Spontaneous vaginal delivery notes she has a concern for ovarian cancer due to her family history. She would like to explore the surgery options since she no longer wants children. She would like to know which method is the most effective for reducing the risk of ovarian cancer; a salpingectomy or tubal ligation.

Search Question: Clearly state the question (including outcomes or criteria to be tracked)

Is a bilateral tubal ligation as effective as a bilateral salpingectomy in preventing Ovarian Cancer?

Question Type: What kind of question is this? (boxes now checkable in Word)

 

☐Prevalence                    ☐Screening          ☐Diagnosis

☐Prognosis                  ☐Treatment          ☐Harms

Assuming that the highest level of evidence to answer your question will be meta-analysis or systematic review, what other types of study might you include if these are not available (or if there is a much more current study of another type)?

Please explain your choices.

I would do a retrospective cohort study. The cohort study would focus on women who have had either a b/l salpingectomy or a b/l tubal ligation and the pregnancy rates after the procedure, respectively.

I would also do a prospective cohort study. Consenting patients undergoing a tubal ligation or a salpingectomy would be followed up until menopause to check for post-procedure pregnancies (including ectopic).

PICO search terms:

Search tools and strategy used:

Please indicate what databases/tools you used, provide a list of the terms you searched together in each tool, and how many articles were returned using those terms and filters.

Explain how you narrow your choices to the few selected articles.

Google Scholar

tubal ligation vs tubal removal cancer rate -> 26,000 results

Tubal ligation vs tubal removal cancer rate + last 10 years -> 16,600 results

Tubal ligation vs tubal removal cancer rate + last 5 years + systematic review + meta-analysis only -> 2,590 results

PubMed  

((salpingectomy[MeSH Terms]) AND (tubal ligation[MeSH Terms])) AND (ovarian cancer [MeSH Terms]) -> 18 results

((salpingectomy[MeSH Terms]) AND (tubal ligation[MeSH Terms])) AND (ovarian cancer [MeSH Terms]) last 5 years -> 7 results

((salpingectomy[MeSH Terms]) AND (tubal ligation[MeSH Terms])) AND (ovarian cancer rates [MeSH Terms]) last 5 years + systematic review/meta- analysis only -> 2 results

TRIP database

tubal ligation AND salpingectomy ovarian cancer-> 181 results

tubal ligation AND salpingectomy ovarian cancer since 2018 -> 70 results

tubal ligation AND salpingectomy ovarian cancer since 2018 + meta-analysis, RCT, systemic review -> 11 results

How I narrowed down my articles:

I searched for keywords such as tubal ligation, salpingectomy, and ovarian cancer. I looked for articles that would provide evidence for the research question. To find a 5th article, I had to remove the filter of systematic review and meta-analysis and include a case-control study. I also had to look at articles published within the last 10 years as opposed to 5. After reading some of the articles’ abstracts, methods, discussions, and conclusions, I narrowed it down to 5 articles. These articles also contained substudies comparing surgical complications and the most effective methods for sterilization.

_______________________________________________

Citation: Adam, S., Badr, M. (2023). Risk-Reducing Salpingectomy And Other Strategies For Prevention Of Ovarian And Tubal Carcinoma. J Gynecol Reprod Med, 7(2), 56-67.

Type of article: Systematic Review

Abstract

Objective: To provide a review of most current evidence and data for risk-reducing strategies used in prevention of ovarian cancer.

Methods of study selection: PubMed was used as a search tool for articles with key words focusing on current strategies on prevention of ovarian cancer such as “risk-reducing salpingectomy, “risk-reducing salpingo-oophorectomy, “salpingectomy with delayed oophorectomy”. General consensus and society guidelines from leading organizations such as Society of Gynecologic Oncology, American Cancer Society, and American College of Obstetricians and Gynecologists were reviewed and summarized in this review article with supporting evidence and research studies on most current risk reduction strategies for prevention of ovarian and tubal carcinoma.

Result: There is growing evidence that high-grade serous ovarian carcinoma arises in the fallopian tube in the form of serous tubal intraepithelial carcinoma (STIC). Therefore, opportunistic salpingectomy has been increasingly offered at the time of routine benign gynecologic surgery. Risk-reducing bilateral salpingo-oophorectomy has been shown to reduce risk of ovarian cancer up to 90% and offered to women with high hereditary predisposition for ovarian cancer. Riskreducing salpingectomy with delayed oophorectomy (SDO) has been suggested in younger women to balance the effects of infertility and surgically induced menopause resulting from oophorectomy.

Conclusion: Combined oral Contraceptive COCs confer long-term protection against ovarian cancer with reported 20% reduction for every 5 years of use, which have been cited as a confounding factor in most of the published studies. Women who used HRT (estrogen alone or combined estrogen and progesterone) carry 20% higher risk of ovarian cancer compared to never-users. The associated increased risk of cervical and breast cancer with COCs/HTR use, have recently let women prefer the RRSO over COCs for prevention of ovarian cancer.

Bilateral risk reducing Salpingo-oophorectomy (RRSO) at the age of 40–45 in BRCA1 and 45–50 in BRCA2 mutation carriers is recommended to be the primary approach for risk reduction of ovarian cancer. There is well-supported evidence of lowering the risk of ovarian cancer in high-risk population by 90%. The American college of obstetrics and gynecology committee opinion, recommended opportunistic salpingectomy for the primary prevention of ovarian cancer in a woman already undergoing pelvic surgery for another indication. Bilateral salpingectomy at the time of cesarean delivery is recommended to replace the tubal ligation as the method of choice for sterilization performed with cesarean delivery.

The novel alternative procedure of Risk-reducing Salpingectomy with delayed risk-reducing oophorectomy (RRSO-RRO) have growing attention as a better alternative to improve the menopause-related morbidity and quality of life

Key Points:

-Bilateral salpingectomy at the time of c-section is recommended to replace tubal ligation as a method of sterilization performed with c-section delivery.

– Bilateral salpingo-oophorectomy has been shown to reduce the risk of ovarian cancer by up to 10%.

– Over the past two decades, opportunistic salpingectomy is used for routine benign gynecologic surgery more than 10-fold.

– Combined oral contraceptives provide a 20% reduction in ovarian cancer every 5 years of use. This confounding variable was noted in some studies.

Why I Chose This Article: This article is a systematic review, was published this year, and provides some evidence to answer the research question. This study’s main goal was to evaluate ovarian cancer rates, but it also performed a sub-study on the efficacy of sterilization. Once again, more research must be done to truly evaluate the efficacy of the two procedures on sterilization.

_______________________________________________________________________________

Citation: Sang-Hee Yoon, Soo-Nyung Kim, Seung-Hyuk Shim, Soon-Beum Kang, Sun-Joo Lee,

Bilateral salpingectomy can reduce the risk of ovarian cancer in the general population: A meta-analysis, European Journal of Cancer, Volume 55,2016,Pages 38-46, ISSN 0959-8049, https://doi.org/10.1016/j.ejca.2015.12.003.

(https://www.sciencedirect.com/science/article/pii/S0959804915011375)

Type of Article: Meta-Analysis

Abstract:

Abstract Background: The results of recent studies have suggested that high-grade serous ovarian cancer predominantly arises within the fallopian tubes. The reduction of ovarian cancer (OC) risk in women with a history of bilateral salpingectomy (BS) has been reported. We performed a meta-analysis to determine the impact of BS in preventing OC in the general population.

Methods: We searched the PubMed, MEDLINE, and EMBASE databases and CENTRAL in the Cochrane Library for all English-language articles published up to January 2015, using the key words ‘ovarian cancer’ and ‘bilateral salpingectomy.’ Odds ratios (ORs) and their 95% confidence intervals (95% CIs) were calculated by standard meta-analysis techniques. Results: Of the 77 studies retrieved, three were included in this meta-analysis, including one cohort study and two population-based case-control studies with 3509 patients who under- went BS and 5,655,702 controls who did not undergo salpingectomy. Over the combined study period, 29 of the 3509 BS patients developed OC compared with 44,006 of the 5,655,702 without salpingectomy. The meta-analysis results based on the fixed effects model revealed a significant decrease in the risk of OC occurrence in the patients who underwent BS relative to the controls (OR Z 0.51, 95% CI 0.35e0.75, I2 Z 0%). This pattern was also observed in subgroup analysis for the study type.

Key Points:  

• Prophylactic Salpingectomy should be considered for women requiring hysterectomy or sterilization.
• According to this meta-analysis, there was a reduction of 49% in ovarian cancer risk after undergoing salpingectomy compared to no procedure.
• This meta-analysis includes four studies due to 73 being excluded during the literature search. There is a significant decrease in ovarian cancer occurrence with a salpingectomy in two studies; however, one study did not find significant evidence of salpingectomy being beneficial.
• 75-80% of epithelial ovarian cancers originate from the fallopian tubes

Why did I choose this article?

I chose this article because it is a meta-analysis that provides a high level of evidence, and it was published within the last seven years. This article provides somewhat of an answer to the question being asked. The downside is that this article only compares those who’ve had their fallopian tubes removed and those who have not. Another reason I chose this article is because it was published in 2016. This shows limited research on the topic, as well as limited conclusions on whether Ovarian cancer is better prevented with a tubal ligation or salpingectomy at that time period, and still in 2023.

_______________________________________________________________________________

Citation: Momenimovahed, Z., Tiznobaik, A., Taheri, S., & Salehiniya, H. (2019). Ovarian cancer in the world: epidemiology and risk factors. International journal of women’s health, 11, 287–299. https://doi.org/10.2147/IJWH.S197604

Type of Article: Systematic Review

Abstract:

Aim: Ovarian cancer is one of the most common gynecologic cancers that has the highest mortality rate. Considering the fact that knowledge on the incidence, mortality of ovarian cancer, as well as its risk factors is necessary for planning and preventing complications, this study was conducted with the aim of examining the epidemiology and risk factors of ovarian cancer in the world.

Materials and methods: In order to access the articles, Medline, Web of Science Core Collection, and Scopus databases were searched from their start to the year 2018. Full-text, English observational studies that referred to various aspects of ovarian cancer were included in the study.

Results: In total, 125 articles that had been published during the years 1925–2018 were entered into the study. Ovarian cancer is the seventh most common cancer among women. Increased risk factors of cancer have led to an upward trend in the incidence of cancer around the world. In 2018, 4.4% of entire cancer-related mortality among women was attributed to ovarian cancer. Although the incidence of cancer is higher among high Human Development Index (HDI) countries, the trend of mortality rate tends to be reversing. Various factors affect the occurrence of ovarian cancer, from which genetic factors are among the most important ones. Pregnancy, lactation, and oral contraceptive pills play a role in reducing the risk of this disease.

Conclusion: This study provides significant evidence about ovarian cancer. Considering the heavy burden of ovarian cancer on women’s health, preventive measures as well as health education and early detection in high risk groups of women are highly recommended. Although some risk factors cannot be changed, a focus on preventable risk factors may reduce the risk of ovarian cancer. More studies are needed to explore the role of unclear risk factors in ovarian cancer occurrence

Key Points: 

• Tubal ligation was associated with a reduced risk of high-grade serous carcinoma by 20%, invasive mucinous cancer by 32%, clear cell cancer by 42%, and endometrioid cancer by (52%)
• Salpingo-oophorectomy in BRCA-positive individuals reduces the risk of ovarian cancer by 75%
• Salpingectomy decreases the risk of ovarian cancer by 35%- 50%

Why did I choose this article?

I chose this article because it is a systematic review and was published in 2019. This article also provides some evidence to answer the research question. It included tubal ligation and salpingectomy in the same study. It was also more specific in specifying what type of ovarian cancer.

—————————

Citation: Prophylactic salpingectomy and ovarian cancer: An evidence-based analysis

Anggraeni et al. DOI: 10.4103/sajc.sajc_187_17

Type of Article: Meta-analysis

Abstract

Introduction: One of the ovarian carcinogenesis theories was the presence of premalignant cells in the epithelium of the fallopian tube. Therefore, the prophylactic salpingectomy during benign gynecological surgery is now expected as the attempt to reduce the ovarian cancer incidence. We studied the effect of prophylactic bilateral salpingectomy (PBS) in reducing the ovarian cancer incidence.

Methods: This evidence-based report resulted from critical appraisal of 5 articles. It is aimed to answer our clinical question, can bilateral prophylactic salpingectomy reduce the incidence of ovarian cancer among women underwent hysterectomy for benign condition or permanent contraception surgery? The search was conducted on the Cochrane Library®, PubMed®, and Embase® using keywords of “prophylactic salpingectomy,” and “ovarian cancer incidence.” Reference lists of relevant articles were searched for other possibly relevant articles.

Results: Five studies were included in our appraisal. The incidence of ovarian cancer among women underwent prophylactic salpingectomy is lower compared to women who were not underwent any intervention (2.2% to 13% and 4.75% to 24.4%). The salpingectomy may reduce 29.2% to 64% of ovarian cancer incidence. No significant effect of PBS to ovarian function, quality of life, sexuality, surgery duration, and its cost-effective profile were also found throughout our literature study.

Conclusion: PBS is suggested to be performed for women during benign gynecological surgery as a primary preventive strategy of ovarian cancer. PBS is a cost-effective procedure, risk-reducing for ovarian cancer and has no significant effect to the ovarian function.

Key Points:

– The incidence of ovarian cancer among women who received opportunistic salpingectomy was lower than those who did not go under any intervention.

– has a low effect on ovarian function after surgery.

– Two of the five articles mentioned that tubal ligation also reduces ovarian cancer rates.

Why I chose this: I chose this article because it is a critical appraisal that has a high level of evidence. It was published within the last three years and directly provides evidence to answer the research question.

————————–

Citation:  Madsen C,Baandrup L, Dehlendorff C, Kjær SK. Tubal ligation and salpingectomy and the risk of epithelial ovarian cancer and borderline ovarian tumors: a nationwide case–control study. Acta Obstet Gynecol Scand 2015; 94:86–94. DOI: 10.1111/aogs.12516

‘

Type of Article: Case-Control Study

Abstract

Objective. According to the recent theories on the ovarian cancer origin, any pro-tective effect of tubal ligation may vary with histologic subtype of ovarian cancer.Furthermore, bilateral salpingectomy may represent an opportunity for surgicalprevention of serous ovarian cancer.Design.Nationwide register-based case–control study.

Setting. Denmark during 1982–2011.Population.Cases were allDanish women diagnosed with epithelial ovarian cancer (n=13 241) or border-line ovarian tumor (n=3605) in the study period. Age-matched female popula-tion controls were randomly selected by risk set sampling. We required that casesand controls have no previous cancer and that controls have no previous bilateraloophorectomy.

Methods. Conditional logistic regression was used to estimateodds ratios and 95% confidence intervals, adjusting for potential confounders.

Main outcome measures. Epithelial ovarian cancer and borderline ovarian tumorsstratified according to histology.

Results. Tubal ligation reduced overall epithelialovarian cancer risk (odds ratios 0.87; 95% confidence interval 0.78–0.98). We observed significant risk variation according to histology (p=0.003) with thestrongest risk reductions associated with endometrioid cancer (odds ratios 0.66;95% confidence interval 0.47–0.93) and epithelial ovarian cancer of “other” his-tology (odds ratios 0.60; 95% confidence interval 0.43–0.83). Tubal ligation wasnot associated with risk of borderline ovarian tumors. Finally, bilateral salpingec-tomy reduced epithelial ovarian cancer risk by 42% (odds ratios 0.58; 95% confi-dence interval 0.36–0.95).Conclusions.We confirmed that tubal ligation reducesthe risk of epithelial ovarian cancer and particularly endometrioid cancer. To ourknowledge, this is the first observational publication to report on salpingectomyand ovarian cancer risk and our promising findings warrant further investigation

Key Points: 

– Tubal ligation reduces the risk of epithelial ovarian cancer.

-This is the first report on salpingectomy and ovarian cancer risk

– With limited statistical precision, it was observed that bilateral salpingectomy reduces the risk of epithelial ovarian cancer by approximately 40%.

-There was an inverse association between uni-latelateral salpingectomy and ovarian cancer.

Why I Chose this article:

I chose this article because it provides evidence to answer the research question. It was difficult to find articles comparing tubal ligation and salpingectomy to prevent ovarian cancer, so I widened my search to articles published in the past ten years. While this is not an RCT or systematic review, it still provides evidence as a case-control study.

Foreign Study Context:

Cultural/Social Context: Scandinavian countries take pride in social equality. Social togetherness allows for social benefits and minimizes gaps producing reduced income disparities.

Economic Context: Scandinavia uses a model that merges capitalism and welfare. They have high tax rates to fund welfare programs; however, they provide universal healthcare, social protection, and high-quality education.

Language: Scandinavian countries, including Denmark, Norway, and Sweden, have their own languages (Danish, Norwegian, and Swedish). English is a prevalent language in these countries that is well understood and spoken.

 

Summary of the Evidence:

 

Conclusion(s):
– Briefly summarize the conclusions of each article, then provide an overarching conclusion.

Adam, S., Badr, M. (2023). Risk-Reducing Salpingectomy And Other Strategies For Prevention Of Ovarian And Tubal Carcinoma. J Gynecol Reprod

This article is a systematic review that aims to provide evidence for risk-reducing factors of ovarian cancer. The article goes over the etiology of ovarian cancer, risk-reducing strategies such as oral contraceptives and opportunistic salpingectomy. It mentions risk factors for ovarian cancer, such as endometriosis. This review included nine articles that led to the conclusion: Combined oral contraceptives offer long-term protection against ovarian cancer. There is a 20% reduction for every five years of use. Women who opted to take hormone replacement therapy had a 20% higher risk of ovarian cancer. This evidence has led to more women preferring risk-reducing salpingo-oophrectomy over combined oral contraceptives to prevent ovarian cancer.

Sang-Hee Yoon, Soo-Nyung Kim, Seung-Hyuk Shim, Soon-Beum Kang, Sun-Joo Lee, (2016).

This is a meta-analysis that aims to determine whether bilateral salpingectomy can prevent ovarian cancer in the general population. They identified 77 studies but only three were included in the meta-analysis. They observed a 49% reduction in ovarian cancer risk compared to those who never received a salpingectomy. This meta-analysis states that prophylactic salpingectomy should be considered for women requiring hysterectomy or sterilization.

Momenimovahed, Z., Tiznobaik, A., Taheri, S., & Salehiniya, H. (2019).

This article is a systematic review that was conducted to examine the epidemiology and risk factors of ovarian cancer. It gathered a total of 125 articles spanning from 1925- 2018. It concluded that ovarian cancer is the seventh most common article among women and risk factors have only increased over time. The genetic factor appears to be the most important. Ovarian cancer risk may be reduced by pregnancy, lactation, and oral contraceptive pills. More importantly, the article states salpingo-oophrectomy in BRCA-positive patients reduces the risk of ovarian cancer by 75%.

Tricia Dewi Anggraeni, Adly Nanda Al Fattah, Raymond Surya (2020)

This article is an evidence-based analysis that aims to evaluate the effect of prophylactic salpingectomy to other methods of prevention of ovarian cancer incidence. The article conducted searches on Cochrane, Pubmed, and Embase. Overall, the article concluded that compared to other methods (tubal ligation, hysterectomy, no procedure), prophylactic salpingectomy may reduce ovarian cancer rates up to 64%.

Cecilie Madsen, Louise, Baandrup, Christian Dehelendorff, Sussane K. KJAER (2014)

This article is a nationwide case-control study done in Scandinavia that aimed to evaluate bilateral salpingectomy and the prevention of serous ovarian cancer. The article concluded that tubal ligation reduced risk of epithelial ovarian cancer. However, since this article was done in 2014, it is the first to report on salpingectomy and ovarian cancer risk, urging for more studies to be done providing more evidence.

Overarching Conclusion:

Both tubal ligation and salpingectomy seem to effectively prevent ovarian cancer by a statistically significant amount. There is also little evidence that one procedure leads to more complications than another. It is important to factor in confounding variables contributing to ovarian cancer risk reduction or increase, such as pregnancy, nulliparity, oral contraceptives, and previous surgeries.

Clinical Bottom Line:

Please include an assessment of the following:

– Weight of the evidence

1) Adam, S., Badr, M. (2023). Risk-Reducing Salpingectomy And Other Strategies For Prevention Of Ovarian And Tubal Carcinoma. J Gynecol Reprod

–  I ranked this article to have the most weight of the evidence because its main objective is to compare risk-reducing salpingectomy to other strategies of ovarian cancer prevention. The other articles in this PICO have substudies that touched upon Salpingectomy but it was not the main objective. I also weighted this first because it is a systematic review which is the highest level of evidence. While this study does not apply to the general population, they concluded that Bilateral Salpingo-oophorectomy at the ages 40-45 in  BRCA1 and BRCA2 mutation carries, a salpingectomy is the primary approach for risk reduction of ovarian cancer.

2) Tricia Dewi Anggraeni, Adly Nanda Al Fattah, Raymond Surya (2020). Prophylactic salpingectomy and ovarian cancer: An evidence‑based analysis

I ranked this article second because it is a critically appraised meta-analysis that provides the highest level of evidence. This study appraises 5 articles which is more than the other mentioned articles. The article also directly provides evidence to the question stating that Prophylactic Bilateral Salpingectomy is suggested to be performed as a primary preventative strategy for ovarian cancer.

3) Sang-Hee Yoon, Soo-Nyung Kim, Seung-Hyuk Shim, Soon-Beum Kang, Sun-Joo Lee, (2016)

-I ranked this article 3rd because its main objective was to directly evaluate the impact of bilateral salpingectomy in reducing the risk of ovarian cancer in the general population. It mentions that tubal ligation has been shown to reduce ovarian cancer risk, but the exact mechanism of the decreased risk remains unknown. This article is a meta-analysis which is the highest level of evidence, but only 3 studies were included in the final meta-analysis

4) Momenimovahed, Z., Tiznobaik, A., Taheri, S., & Salehiniya, H. (2019).

I ranked this article fourth because its main objective is to examine the epidemiology and risk factors of ovarian cancer.  This article is a systematic review and includes 125 articles included articles from 1925-2018. The article mentions Salpingo-oophorectomy in BRCA-positive individuals reduces the risk of ovarian cancer by 75%. It also mentions a cohort study in which tubal ligation was associated with a 20% risk reduction of high-grade serous carcinomas. However, the article does not provide more in-depth individual results.

5)  Cecilie Madsen, Louise, Baandrup, Christian Dehelendorff, Sussane K. KJAER

I ranked this article last in weight of evidence because it is a case-control study. This is also a foreign article that was published in 2014. The article mentions it is the first to assess salpingectomy and ovarian cancer rates.

 

Magnitude of Effects

1. Adam, S., Badr, M. (2023). Risk-Reducing Salpingectomy And Other Strategies For Prevention Of Ovarian And Tubal Carcinoma. J Gynecol Reprod. This article does not directly list a summary of all included studies and the magnitude of the effects. However, starting from page 8 of the PDF linked here, it lists the individual magnitude of effects for each article. Also, 5 of the articles are still pending results to conclude their magnitude of effects.

1.  Sang-Hee Yoon, Soo-Nyung Kim, Seung-Hyuk Shim, Soon-Beum Kang, Sun-Joo Lee, (2016). Of the three selected studies, two found that BS significantly reduces the risk of OC. The other study did not find significant evidence of a difference; however, the direction of the effect was in favor of BS reducing the risk of OC. A meta-analysis of the above three studies confirmed that BS reduces the risk of OC by 49% (OR =.51; 95%CI = 0.35-0.75; P<0.001). As no heterogeneity existed among studies(P =0.553; and I2 =0%), the fixed effects model was used.

1. Momenimovahed, Z., Tiznobaik, A., Taheri, S., & Salehiniya, H. (2019).  The risk of ovarian cancer was reduced in women with tubal ligation. In a cohort study, tubal ligation was associated with a 20% reduction in risk of high-grade serous carcinoma. Women with tubal ligation have a decreased risk of invasive serous cancer(19%), invasive mucinous cancer(32%), clear cell cancer(42%), and endometrioid cancer(52%). No association was found between tubal ligation and low-grade serous tumors. Salpingooophorectomy in BRCA-positive individuals reduces the risk of ovarian cancer by 75%. Since, most epithelial cancers originate from the fallopian tube, salpingectomy decreases the risk of ovarian cancer by 35–50%.

1. Tricia Dewi Anggraeni, Adly Nanda Al Fattah, Raymond Surya, 2020. They revealed the risk of incidence of ovarian cancer was lower 49% among the patients who underwent bilateral salpingectomy compared to the controls (OR: 0.51, 95% CI 0.35‑0.75).[14] In our study, PBS may reduce 29.2% to 64% of ovarian cancer incidence

1. Cecilie Madsen, Louise, Baandrup, Christian Dehelendorff, Sussane K. KJAER  Based on 29 women (five cases and 24 controls) who had undergone excisional tubal sterilization, the authors reported that the surgical procedure reduced the risk of serous ovarian cancer and primary peritoneal cancer by more than 60% (OR=0.38; 95% CI 0.14–1.06). These promising findings require confirmation by future studies, ideally with a larger sample size. At best, bilateral salpingectomy could represent a preventive intervention for women undergoing hysterectomy for benign disease, requesting permanent contraception, or for women at high genetic risk of ovarian cancer with ovarian preservation.

– Clinical significance (not just statistical significance)

Overall, the five articles provide evidence that both tubal ligation and salpingectomy lead to reduced ovarian cancer rates. However, this does not directly answer the clinical question of which procedure is more effective. I suspect this is due to a negligible difference in quality because neither procedure leads to more peri-surgical or post-surgical complications. It is important to note that none of the articles mentioned rates of ectopic pregnancies or sterilization failure with tubal ligation.

For this question to be answered in-depth, an article directly comparing the two sterilization procedures is needed. However, this study may not be available because both methods are effective. It is only serous carcinoma that is prevented more with salpingectomy than tubal ligation; this is only one type of cancer. Additionally, articles need to contain a larger sample size so that results can be generalized to women who are not BRCA carriers or BRCA-positive patients.

References

Adam, S., Badr, M. (2023). Risk-Reducing Salpingectomy And Other Strategies For Prevention Of Ovarian And Tubal Carcinoma. J Gynecol Reprod Med, 7(2), 56-67.

PDF:
Article 1.pdf
Anggraeni et al. Prophylactic salpingectomy and ovarian cancer: An evidence-based analysis. DOI: 10.4103/sajc.sajc_187_17

PDF:
Article 2
Madsen C,Baandrup L, Dehlendorff C, Kjær SK. Tubal ligation and salpingectomy and the risk of epithelial ovarian cancer and borderline ovarian tumors: a nationwide case–control study. Acta Obstet Gynecol Scand 2015; 94:86–94. DOI: 10.1111/aogs.12516

PDF:
Article 3 

Momenimovahed, Z., Tiznobaik, A., Taheri, S., & Salehiniya, H. (2019). Ovarian cancer in the world: epidemiology and risk factors. International journal of women’s health, 11, 287–299. https://doi.org/10.2147/IJWH.S197604

PDF:
Article 4

Sang-Hee Yoon, Soo-Nyung Kim, Seung-Hyuk Shim, Soon-Beum Kang, Sun-Joo Lee,

Bilateral salpingectomy can reduce the risk of ovarian cancer in the general population: A meta-analysis, European Journal of Cancer, Volume 55,2016,Pages 38-46, ISSN 0959-8049, https://doi.org/10.1016/j.ejca.2015.12.003.

(https://www.sciencedirect.com/science/article/pii/S0959804915011375)

PDF:Article 5

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2774561

https://www.weforum.org/agenda/2019/01/what-can-america-learn-from-sweden-about-healthcare/