For decades, tubo-ovarian cancer has been the most lethal gynaecological malignancy, with negligible improvement in the 5-year survival rates over the past decades despite advancements in treatment. This reality, described in the European Society of Gynaecological Oncology (ESGO) consensus report, underscores the urgency of effective prevention strategies.1 The growing recognition that many high-grade serous ovarian cancers originate from the fallopian tube has catalysed a paradigm shift: prevention lies in removing the fallopian tube, not the ovary.
Opportunistic salpingectomy, which refers to the removal of the fallopian tubes during abdominal surgery for other indications, has emerged as a promising pragmatic intervention. The ESGO consensus statements, developed through a Delphi process and grounded in a review of 129 studies, offer a strong endorsement for integrating this procedure into routine surgical practice for women who do not desire future fertility.
A strong case for tubo-ovarian cancer prevention
The evidence supporting opportunistic salpingectomy is compelling. Multiple systematic reviews and meta-analyses demonstrate substantial reductions in tubo-ovarian carcinoma risk. Sowamber et al
2 reported that bilateral salpingectomy could reduce tubo-ovarian cancer risk by up to 80%, and Kahn et al
3 calculated that this intervention can potentially lower ovarian cancer mortality by 15%. Tang et al
4 similarly found a significant risk reduction (OR 0.48; 95% CI 0.33 to 0.69). These findings are reinforced by large population-based studies, including the studies from Falconer, which showed a HR of 0.35 for women who had undergone salpingectomy5 and Madsen (OR 0.58; 95% CI 0.36 to 0.95).6 While randomised trials are lacking, an inherent challenge in studying rare cancers, the consistency of observational data across populations and methodologies strengthens the argument for action.
Reassuring evidence for the ovarian function
One of the most important concerns has been the potential impact of salpingectomy on ovarian reserve. The ESGO review provides reassuring clarity: short-term ovarian function appears unaffected. Randomised trials by Asgari et al
7 and Findley et al
8 found no significant postoperative differences in ovarian reserve markers between women who underwent hysterectomy with or without salpingectomy. Long-term data remain limited and somewhat mixed. A Swedish registry study reported increased menopausal symptoms 1 year postoperatively in women who underwent an opportunistic salpingectomy. However, women in the intervention group were significantly older than women in the control group,9 while a large Canadian cohort found no difference in time to menopause-related physician visits or hormone therapy use.10 Therefore, ESGO emphasises that long-term evidence is lacking, and counselling should reflect this uncertainty, particularly for younger women.
Safety and feasibility across surgical settings
The consensus statements highlight that opportunistic salpingectomy is safe, adds minimal operative time and is feasible across surgical approaches. Trials during caesarean delivery show an average increase of less than 15 min, with no increase in complications. Notably, feasibility extends beyond gynaecology. Studies from Austria and Canada demonstrate successful salpingectomy during cholecystectomy and bariatric surgery, with completion rates above 90% and no attributable complications. Although evidence remains scant, these findings open the door to tubo-ovarian cancer prevention across surgical disciplines.
A call for consistent implementation
Despite strong evidence and endorsements from multiple professional societies, including Fédération Internationale de Gynécologie et d'Obstétrique (FIGO), Society of Gynecologic Oncology (SGO) and now also ESGO, implementation remains inconsistent. Barriers include variable surgical training, medicolegal concerns and lack of standardised pathways in nongynaecological procedures. Therefore, we call for structured implementation strategies.
The consensus also stresses the importance of informed consent. Because salpingectomy is a sterilising procedure, it must never be performed without clear documentation of a patient’s reproductive intentions. Younger women, in particular, should be counselled about the permanence of the procedure and the limited data on long-term ovarian health.11
Where evidence is still needed
The ESGO group identifies several critical gaps: long-term endocrine outcomes, especially in women under 35, feasibility and outcomes in nongynaecological surgeries. Implementation strategies across diverse health systems. Therefore, prospective studies and ongoing clinical trials (like: NCT04757922, NCT07423143 and NCT03045965) are essential to refine recommendations and address these uncertainties.
A preventive opportunity we should not miss
The ESGO consensus statements represent a significant milestone. They synthesise a large and complex body of evidence into clear, actionable guidance: opportunistic salpingectomy should be offered to all eligible women undergoing gynaecological surgery and considered during selected nongynaecological procedures. The intervention is safe, feasible and supported by strong evidence of cancer risk reduction. Therefore, clinicians should include this prevention intervention in preoperative counselling of eligible women (https://decisionaid-fallopiantuberemoval.org).12 Given the devastating impact of ovarian cancer and the absence of effective screening, the case for opportunistic salpingectomy is in our opinion very strong.
The challenge now is not scientific, it is implementation. With coordinated efforts across specialties, health systems and professional societies, opportunistic salpingectomy could become one of the most impactful cancer prevention strategies of our time.
