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BackTable / OBGYN / Podcast / Episode #24

Opportunistic Salpingectomy

with Dr. Rebecca Stone and Kara Long Roche

In this episode, Drs. Mark Hoffman and Amy Park invite Drs. Rebecca Stone and Kara Long Roche to speak about opportunistic salpingectomy to prevent ovarian cancer, specifically serous carcinoma.

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Opportunistic Salpingectomy with Dr. Rebecca Stone and Kara Long Roche on the BackTable OBGYN Podcast)
Ep 24 Opportunistic Salpingectomy with Dr. Rebecca Stone and Kara Long Roche
00:00 / 01:04

BackTable, LLC (Producer). (2023, June 1). Ep. 24 – Opportunistic Salpingectomy [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Rebecca Stone discusses Opportunistic Salpingectomy on the BackTable 24 Podcast

Dr. Rebecca Stone

Dr. Rebecca Stone is an Associate Professor of OB/GYN and Director of the Kelly Gynecologic Oncology Service at Johns Hopkins.

Dr. Kara Long Roche discusses Opportunistic Salpingectomy on the BackTable 24 Podcast

Dr. Kara Long Roche

Dr. Kara Long Roche is the Associate Director for GYN ONC fellowship in the Dept. of Surgery at Memorial Sloan Kettering Cancer Center in the section of ovarian cancer surgery.

Dr. Amy Park discusses Opportunistic Salpingectomy on the BackTable 24 Podcast

Dr. Amy Park

Dr. Amy Park is the Section Head of Female Pelvic Medicine & Reconstructive Surgery at the Cleveland Clinic, and a co-host of the BackTable OBGYN Podcast.

Dr. Mark Hoffman discusses Opportunistic Salpingectomy on the BackTable 24 Podcast

Dr. Mark Hoffman

Dr. Mark Hoffman is a minimally invasive gynecologic surgeon at the University of Kentucky.

Synopsis

The episode begins discussing ovarian cancer as a whole and how it affects 1 in 78 women in their lifetime with high mortality rates, no screening tests, and hardly any symptoms before it becomes metastatic. Most ovarian cancers (80-90%) are epithelial, and of those, most are high grade serous carcinomas, which are very lethal.

Drs. Stone and Long Roche go on to explain how ovarian cancer is actually disseminated tubal cancer, and that there is data showing dysplasia in the fallopian tube before it turns into ovarian cancer. In fact, the fimbriated ends of the fallopian tube are very high in p53 mutations, and there is data showing a decreased risk of ovarian cancer with tubal ligation. As a result, salpingectomy can be used as primary prevention for ovarian cancer. They have been doing opportunistic salpingectomies on women already in the OR for hysterectomies, Cesarean sections, ovarian cystectomies, etc. They would like to expand it to women receiving abdominal or urologic surgeries, including hernia repairs or cholecystectomies, which would require education, training, and communication across multidisciplinary teams.

The physicians continue to discuss the impact of opportunistic salpingectomies, mentioning 2000 lives could be saved every year in addition to 0.5 billion health care dollars saved as a result. They compare it to the HPV vaccine with a number needed to treat around 1 in 300 to 1 in 500 and a risk reduction of 65% or greater.

Technically speaking, the physicians mentioned the difficulties of ensuring adequate fimbriae removal of the ovary without causing more harm; overall, data shows that if done correctly, this procedure does not result in early menopause or impaired ovarian function. They also stated there is no specific procedure code for opportunistic salpingectomy along with conflicting state laws on reimbursability for the procedure, which could affect data collection and implementation.

Finally, the episode ends with talk about the future of opportunistic salpingectomies. Data shows there is a decreased incidence of high grade serous ovarian carcinoma, but more data is needed on mortality effects. The physicians strive to educate providers and patients about the procedure while ensuring no woman becomes sterilized before she is ready. Their target population is women in their 40s who will be in the OR already, as they don’t see opportunistic salpingectomies becoming indicated for the general population soon.

Resources

Transcript Preview

[Kara Long Roche MD]
I think that strong family history of ovarian cancer or ovarian cancer in a first-degree relative, these patients don't fit anywhere in the guidelines neatly. We tell them they probably have a higher risk, maybe up to 5% of their lifetime and yet there's no place where they fall and I totally agree that salpingectomy as a standalone procedure may be the perfect middle ground for these patients to act on risk reduction without the supply of a premenopausal BSO.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Articles

Opportunistic Salpingectomy as a Preemptive Treatment for High-Risk Ovarian Cancer

Opportunistic Salpingectomy: High-Risk Ovarian Cancer Preemptive Treatment

Opportunistic Salpingectomy Surgery: A Technical Guide

Opportunistic Salpingectomy Surgery: A Technical Guide

Topics

Hysterectomy Procedure Prep

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