Ovarian cancer is one of the commonest gynecological cancers among women, presenting at an advanced stage and therefore having a poor prognosis, with a low 5 year survival rate. This is due to the fact that there are no adequate screening techniques available for the detection of ovarian cancer.

Of late, the fallopian tube is thought to be either the site of the primary cancer or the conduit for the carcinogens or neoplastic cells

There is evidence to show that in women who had previously undergone a tubal ligation, there is a decreased risk of ovarian cancer in later life.  In addition, pathological examination of fallopian tubes in high risk women who underwent a prophylactic risk reducing bilateral salpingo-oophorectomy showed precancerous lesions in the fallopian tube and not in the ovary. This forms the basis for opportunistic salpingectomy where both the fallopian tubes are removed (totally or partially) in patients who are undergoing pelvic surgery for benign conditions thereby decreasing their risk of ovarian cancer in later life. 

The current dilemma among gynecologists is whether an opportunistic salpingectomy causes damage to ovarian blood supply and there-by decreasing its function.  We intend to study the same, by randomizing patients planned for hysterectomy for benign conditions into two groups, one with a salpingectomy and the other without, and assessing their ovarian function by comparing the difference in FSH levels at six months to one year post-operatively. FSH levels increase due to loss of negative feedback from ovarian hormones. The correlation of an increased FSH and menopausal transition have been well studied previously. We will be using FSH as a surrogate marker for ovarian hormone production.

We hope to show that there will not be a significant difference between the two groups and thus we can offer this procedure to more patients without concern of compromising ovarian function.

Methodology: Patients planned for hysterectomy will be informed about the nature of the study and consenting patients will be recruited. A blood sample will be sent for analysis of FSH value. Once the patient reaches the operating theater, she will randomly be allotted to either arm of the study via block randomization and using opaque sealed envelopes which will be kept locked inside the operation theater. Intra-operatively, the following details will be collected by the surgical team: total duration of surgery, duration of only salpingectomy, estimated total blood loss, estimated blood loss during salpingectomy alone, cold knife or cautery used for salpingectomy, intra-operative complications due to salpingectomy or failure of intended surgery due to salpingectomy. If patient is in the intervention arm and total salpingectomy is not possible, a partial salpingectomy (removal of a part of the tube) will be done. If this as well is not possible, the procedure will be abandoned and the patient will no longer be a part of the study. If patient is in the control arm and intra-operatively is found to have an abnormality of the fallopian tubes or ovaries, they may be removed and the patient will no longer be a part of the study.

Prior to discharge, patient will be asked to follow up after six months to one year with a repeat FSH value and at the time they will be interviewed for symptoms of hot flushes or genitourinary symptoms.