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首页> 外文期刊>Gynecologic oncology research and practice. >Opportunistic salpingectomy for ovarian cancer prevention
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Opportunistic salpingectomy for ovarian cancer prevention

机译：机会性输卵管切除术预防卵巢癌

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Recently accumulated evidence has strongly indicated that the fallopian tube is the site of origin for the majority of high-grade serous ovarian or peritoneal carcinomas. As a result, recommendations have been made to change surgical practice in women at general population risk for ovarian cancer and perform bilateral salpingectomy at the time of hysterectomy without oophorectomy and in lieu of tubal ligation, a practice that has been termed opportunistic salpingectomy (OS). Despite suggestions that bilateral salpingectomy may be used as an interim procedure in women with BRCA1/2 mutations, enabling them to delay oophorectomy, there is insufficient evidence to support this practice as a safe alternative and risk-reducing bilateral salpingo-oophorectomy remains the recommended standard of care for high-risk women. While evidence on uptake of OS is sparse, it points toward increasing practice of OS during hysterectomy. The practice of OS for sterilization purposes, although expanding, appears to be less common. Operative and perioperative complications as measured by administered blood transfusions, hospital length of stay and readmissions were not increased with the addition of OS either at time of hysterectomy or for sterilization. Additional operating room time was 16 and 10?min for OS with hysterectomy and OS for sterilization, respectively. Short-term studies of the consequences of OS on ovarian function indicate no difference between women undergoing hysterectomy alone and hysterectomy with OS, but no long-term data exist. There is emerging evidence of effectiveness of excisional sterilization on reducing ovarian cancer rates from Rochester (OR?=?0.36 95 % CI 0.13, 1.02), and bilateral salpingectomy from Denmark (OR?=?0.58 95 % CI 0.36, 0.95) and Sweden (HR?=?0.35, 95 % CI 0.17, 0.73), but these studies suffer from limitations, including that they were performed for pathological rather than prophylactic purposes. Initial cost-effectiveness modeling indicates that OS is cost-effective over a wide range of costs and risk estimates. While preliminary safety, efficacy, and cost-effectiveness data are promising, further research is needed (particularly long-term data on ovarian function) to firmly establish the safety of the procedure. The marginal benefit of OS compared with tubal ligation or hysterectomy alone needs to be established through large prospective studies of OS done for prophylaxis
机译：最近积累的证据强烈表明，输卵管是大多数高级浆液性卵巢癌或腹膜癌的起源地。因此，已提出建议，建议改变一般有卵巢癌风险的女性的手术方法，并在不进行输卵管切除术和代替输卵管结扎术的子宫切除术时进行双侧输卵管切除术，这种方法被称为机会性输卵管切除术（OS）。 。尽管有人建议将双侧输卵管切除术作为BRCA1 / 2突变女性的临时治疗方法，使她们能够延迟输卵管切除术，但尚无足够的证据支持这种做法，因为这是一种安全的替代方法，降低双侧输卵管输卵管卵巢切除术仍是推荐的标准对高危妇女的照顾。尽管关于OS摄取的证据很少，但它表明子宫切除术中OS的使用越来越多。用于消毒目的的OS的实践虽然扩展了，但似乎不太普遍。在子宫切除术或用于绝育时，增加OS并不会增加通过输血，住院时间和再入院所导致的手术和围手术期并发症。带子宫切除术的OS和用于消毒的OS的额外手术室时间分别为16和10？min。对OS对卵巢功能的影响的短期研究表明，仅接受子宫切除术的妇女和接受OS子宫切除术的妇女之间没有差异，但是没有长期数据。罗切斯特（OR = 0.36 95％CI 0.13，1.02）和丹麦的双侧输卵管切除术（OR = 0.58 95％CI 0.36，0.95）的行卵巢切除术降低卵巢癌发生率的有效性的新兴证据。 （HR≥0.35，95％CI 0.17，0.73），但是这些研究有局限性，包括它们是出于病理目的而不是预防目的。最初的成本效益模型表明，OS在各种成本和风险估算中都具有成本效益。尽管初步的安全性，有效性和成本效益数据令人鼓舞，但仍需要进一步研究（尤其是卵巢功能的长期数据）以牢固地确定手术的安全性。与仅进行输卵管结扎或子宫切除术相比，OS的边际益处需要通过对OS进行的大量前瞻性研究来确定

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