What is a salpingo-oophorectomy?

Definition of Salpingo-oophorectomy

Salpingo-oophorectomy is a surgical procedure that involves the removal of the fallopian tube (salpingectomy) and ovary (oophorectomy) from one side (unilateral) or both sides (bilateral) of the female reproductive system. 1

Types of Salpingo-oophorectomy

1. Unilateral Salpingo-oophorectomy (USO)

   • Removal of one fallopian tube and one ovary
   • Often performed for:
     • Ovarian cysts or tumors limited to one side
     • Early-stage ovarian cancer in young women desiring fertility preservation 1
     • Endometriomas (endometriosis of the ovary) 2

2. Bilateral Salpingo-oophorectomy (BSO)

   • Removal of both fallopian tubes and both ovaries
   • Common indications include:
     • Risk reduction in BRCA1/2 mutation carriers 1
     • Advanced ovarian cancer 1
     • Part of complete surgical staging for gynecologic malignancies 1

Clinical Applications

Risk-Reducing Surgery

Bilateral salpingo-oophorectomy is recommended for:

• Women with BRCA1 mutations, typically between ages 35-40 1
• Women with BRCA2 mutations, typically between ages 40-45 1
• Women with Lynch syndrome (MLH1 mutation carriers), may be considered starting at age 40 1

Risk reduction benefits:

• Reduces ovarian cancer risk by 80-95% 3, 4
• Reduces breast cancer risk by approximately 50% in BRCA1/2 mutation carriers 1
• However, there remains a 1-4.3% residual risk for primary peritoneal carcinoma 1, 4

Surgical Management of Cancer

In ovarian cancer management:

• For early-stage disease limited to the ovaries in post-menopausal women: total hysterectomy and bilateral salpingo-oophorectomy with complete staging 1
• For young patients with early-stage disease desiring fertility preservation: unilateral salpingo-oophorectomy with preservation of the contralateral ovary and uterus 1, 5
• For advanced disease: bilateral salpingo-oophorectomy as part of complete tumor debulking 1

Emerging Alternatives

Recent evidence suggests that:

• Bilateral salpingectomy with ovarian retention (BSOR) may be an option for premenopausal women at risk for ovarian cancer who wish to avoid surgical menopause 6
• Opportunistic salpingectomy during benign gynecologic surgery may reduce ovarian cancer risk without affecting ovarian function 7
• This approach is based on evidence that many high-grade serous ovarian cancers originate in the fallopian tube epithelium 6

Considerations and Consequences

Important considerations include:

• Surgical menopause in premenopausal women after bilateral oophorectomy
• Potential need for hormone replacement therapy after BSO 1
• Impact on bone health, cardiovascular health, and quality of life 7
• Fertility implications in younger women

Conclusion

Salpingo-oophorectomy is a critical surgical procedure in gynecologic oncology, used both for treatment of existing disease and risk reduction in high-risk populations. The decision between bilateral versus unilateral procedures, and whether to include concurrent hysterectomy, depends on the patient's age, cancer risk factors, disease stage, and fertility desires.