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Opportunistic Adnexal Surgery

Opportunistic adnexal surgery, most commonly opportunistic salpingectomy (OS), refers to removal of the fallopian tubes for primary prevention of tubo-ovarian carcinoma in women already undergoing pelvic or abdominal surgery for another indication.[1][2]

Part I: Scientific rationale — the tubal hypothesis​

The foundation of opportunistic salpingectomy rests on a paradigm shift in understanding ovarian cancer pathogenesis:

Serous tubal intraepithelial carcinoma (STIC). Premalignant cells and early occult cancers have been detected in the fimbrial funnel region of the fallopian tube, but not on the ovarian surface, in risk-reducing salpingo-oophorectomy (RRSO) specimens from BRCA carriers.[3][4] STICs are detected alongside a substantial proportion of high-grade serous carcinomas; detection frequency depends on specimen sampling. They may be missed on routine pathological examination.[4] These findings challenged the traditional view that high-grade serous ovarian cancer (HGSOC), the most common and lethal subtype, originates from the ovarian surface epithelium.

Pathologic precursors distributed along the tube:[1]

  • Serous tubal intraepithelial lesions (STILs) and tubal intraepithelial lesions in transition are most frequently located in the fimbriated end.
  • Secretory cell outgrowths (SCOUTs) are distributed throughout the tube, supporting complete salpingectomy over fimbriectomy alone.

Part II: Magnitude of cancer-risk reduction​

The European Society of Gynaecological Oncology (ESGO) consensus published in JAMA (2026) synthesized the evidence:[6]

  • A 2025 meta-analysis (Tang et al.) of five case-control studies found that bilateral salpingectomy was associated with lower epithelial ovarian cancer odds (OR 0.48; 95% CI 0.33–0.69; p<0.001).[6][37]
  • Swedish population-based cohort (Falconer et al.): 65% risk reduction (HR 0.35; 95% CI 0.17–0.73) after bilateral salpingectomy compared with unexposed women.[6][1]
  • Danish nationwide case-control (Madsen et al.): 42% risk reduction (OR 0.58; 95% CI 0.36–0.95).[6]
  • Danish nationwide case-control study (Duus et al., 2023; 16,822 EOC cases, each matched to 40 controls): risk reduction after both unilateral (OR 0.73; 95% CI 0.60–0.87) and bilateral salpingectomy (OR 0.46; 95% CI 0.31–0.67), with the protective effect increasing with time since surgery and present across most histological subtypes; the association was confined to surgery before age 50 in this study.[7]
  • Kahn et al. (2023) reviewed 158 publications and projected that widespread implementation could lower US ovarian-cancer mortality by 15%.[5]

These estimates come from observational studies with different comparators, histologies, and follow-up. A 2026 British Columbia cohort (40,527 salpingectomy; 45,296 comparator operations) found a crude HR 0.22 (95% CI 0.05–0.95) for serous ovarian cancer, combining high- and low-grade cases because grade data were incomplete.[30] Few events, younger age, shorter follow-up, and incomplete confounder adjustment limit causal precision.[30] In a 2026 Ontario cohort, 19 epithelial cancers occurred among 57,941 salpingectomy patients versus 123 among 138,898 patients who underwent comparator surgery (adjusted HR 0.60; 95% CI 0.36–0.98).[35] The serous-cancer analysis combined high- and low-grade disease (adjusted HR 0.47; 95% CI 0.22–0.99).[35]

Part III: Guideline recommendations​

SocietyYearRecommendation
ACOG (Clinical Practice Update to CO 774)August 2026Routinely perform bilateral salpingectomy at hysterectomy; recommend it at nonhysterectomy gynecologic surgery that enters the peritoneal cavity when future fertility is not desired; complete bilateral salpingectomy is the preferred tubal procedure for permanent contraception after shared decision making (partial salpingectomy only when complete is unsafe, infeasible or declined); support other specialists offering salpingectomy at nongynecologic surgery. Consider successful completion of salpingectomy when counseling about surgical approach.[28]
ESGO (consensus statements)2026Consider OS for all eligible women undergoing gynecologic pelvic surgery or nongynecologic pelvic or selected abdominal surgery .[6]
NICE (familial/genetic risk, NG241)2024For high-risk patients, salpingectomy with delayed oophorectomy should be offered only in a clinical trial; it is not established as equivalent to RRSO.[29]
FIGO2024Supports OS during benign gynecologic surgery and consideration during unrelated abdominal or pelvic surgery after counseling and informed consent.[44]
German AGO / NOGGO / AGO Austria / AGO Swiss2015 positions; 2025 intergroup statementGerman AGO advised counseling at hysterectomy in 2015 without a general recommendation; Austrian AGO favored broad use. The 2025 intergroup statement recommends offering OS during routine gynecologic surgery to women who have completed childbearing.[3]
[1][2][6][8][3]

Part IV: Surgical technique​

Complete salpingectomy principles (ACOG)[1]​

  1. Remove the tube completely from its fimbriated end up to the uterotubal junction (cornua).
  2. The interstitial portions of the tubes do not need to be removed.
  3. Any fimbrial attachments on the ovary should be cauterized or removed.
  4. Complete salpingectomy is preferred over fimbriectomy because precursors can be found throughout the tube.
  5. If complete salpingectomy cannot be performed, removing as much tube as possible (excluding the interstitial portion) still has value.

RRSO principles — for high-risk patients​

Observational cohorts of BRCA1/2 carriers associate RRSO with longer overall survival and lower high-grade serous cancer mortality overall; the cited Cochrane review rated both outcomes very low certainty and found the BRCA2-specific cancer-mortality effect uncertain because few deaths occurred.[10] Follow the current specialist risk-reduction protocol, including:[29]

  • NICE NG241 recommends transvaginal ultrasonography and serum CA125 before RRSO to reduce the chance of missing asymptomatic ovarian cancer, and endometrial biopsy before concomitant risk-reducing hysterectomy to reduce the chance of missing asymptomatic endometrial cancer. Use minimal-access surgery unless laparotomy is clinically more appropriate.[29]
  • Survey upper abdomen, bowel surfaces, omentum, appendix, and pelvic organs.
  • Biopsy any abnormal peritoneal findings.
  • Obtain peritoneal washings for cytology.
  • Remove both tubes and ovaries completely with appropriate specimen handling and pathological assessment; incidental cancer requires gynecologic-oncology management.
  • Handle the specimen minimally to avoid traumatic exfoliation of cells.
  • Retrieve specimens in an endobag, then submit right and left adnexa in separate, appropriately labeled containers so laterality is available to pathology.[29]
  • Process by SEE-FIM protocol (Sectioning and Extensively Examining the Fimbriated End).

SEE-FIM protocol​

The fimbriated end is amputated and sectioned longitudinally, while the remainder of the tube is sectioned at 2–3 mm intervals. Extensive sampling improves detection of small precursor lesions. An isolated STIC finding after salpingectomy or RRSO warrants expert gynecologic-pathology review, germline testing, and gynecologic-oncology assessment of completion surgery and peritoneal staging.[42][43] An older US laboratory survey documented variable SEE-FIM use.[11]

Surgical completeness​

In the QOS study, 115 patients already scheduled for unilateral or bilateral adnexectomy underwent salpingectomy followed by oophorectomy; pathology of 201 adnexa found complete fimbrial removal in about 88% of patients.[12] Residual microscopic fimbrial tissue was identified in 7.4% of adnexa (12.2% of patients). No STIC lesions were detected in residual tissue. Clinical impact of remnant fimbrial tissue on cancer-risk reduction remains uncertain.[12]

Part V: Safety and perioperative outcomes​

A. At hysterectomy​

ACOG states that salpingectomy at the time of hysterectomy does not increase the risk of complications (blood transfusions, readmissions, postoperative complications, infections, or fever) compared with hysterectomy alone.[1][2] An RCT (Song et al., n = 68) found no significant differences in operative time, blood loss, or complications between hysterectomy with and without OS.[6]

B. At cesarean delivery​

  • An RCT (Subramaniam et al., n = 80) found OS added a mean of 15 minutes compared with tubal ligation during cesarean delivery (75.4 vs 60.0 min), with no adverse outcomes directly related to sterilization. Bilateral completion was 27/40 (68%) with salpingectomy versus 38/40 (95%) with ligation.[32]
  • British Columbia population-based cohort (Rufin et al., 2024; n = 18,184): OS was associated with lower odds of perioperative complications than tubal ligation (aOR 0.77; 95% CI 0.61–0.99); no difference in postoperative complications or readmissions. Slightly increased odds of filling NSAID (aOR 1.18) and opioid (aOR 1.23) prescriptions.[13]
  • US national study (Mandelbaum et al., 2021; n = 3.8 million cesarean deliveries): in the fourth quarter of 2018, 13.2% of cesarean deliveries included bilateral salpingectomy (up from 4.6% in the fourth quarter of 2015), surpassing tubal ligation. In propensity-matched analysis, the salpingectomy group had higher rates of hemorrhage (3.8% versus 3.1%), transfusion (2.1% versus 1.8%), hysterectomy (0.8% versus 0.4%), and oophorectomy (0.3% versus 0.2%).[14]

C. At non-gynecologic surgery​

For nongynecologic surgery, the 2026 ESGO consensus cites salpingectomy completed in 98/105 laparoscopic cholecystectomy patients and 18/19 bariatric patients, with no additional perioperative complications attributed to salpingectomy in either series.[6] ESGO statement 18 cautions that adding salpingectomy during vaginal hysterectomy may increase complications, although major complications remain uncommon.[6] A 2024 meta-analysis of seven observational cohorts found bilateral completion in 81.8% of attempted cases (95% CI 75.4–87.5%); the evidence was rated low certainty.[39] The ESGO caution addresses added salpingectomy during vaginal hysterectomy, without comparing hysterectomy routes.[6]

Part VI: Impact on ovarian function​

The mesosalpinx contains anastomosing uterine and ovarian vessels. Dissection close to the tubal wall spares this vascular arcade during salpingectomy.[3]

Short-term ovarian reserve (reassuring):

  • Systematic review and meta-analysis (Gelderblom et al., 2022; 15 studies): no significant reduction in AMH (MD −0.07 ng/mL; 95% CI −0.18 to 0.05), AFC, E2, FSH, or LH after OS.[15]
  • A 2017 meta-analysis (Mohamed et al.; six before-and-after studies, n = 464, with mixed indications and 3–6-month follow-up) found no statistically significant short-term change in AMH after salpingectomy (weighted mean difference −0.10 ng/mL; 95% CI −0.19 to 0.00; I² = 0%).[6][38]
  • Small randomized trials reported no statistically significant difference in AMH or FSH at 3 months.[6] In the HOPPSA randomized substudy, 37 patients per group were analyzed at 1 year; the adjusted between-group difference in AMH decline was −0.03 μg/L (95% CI −0.23 to 0.18), and noninferiority was not demonstrated.[36]

Long-term menopause outcomes (mixed):

  • British Columbia cohort (Hanley et al., 2020; n = 41,413): no increased hazard of physician visits for menopause (aHR 0.98; 95% CI 0.88–1.09) or filling HRT prescriptions after OS at hysterectomy, including age-stratified analyses with ≥5 years of follow-up.[16]
  • Swedish registry study (Collins et al.): 33% increased risk of menopausal symptoms 1 year after hysterectomy with OS compared with hysterectomy alone (RR 1.33; 95% CI 1.04–1.69).[6]

The ESGO consensus concludes that OS does not impair short-term ovarian function and does not appear to affect age at menopause, but long-term data remain limited and a possible impact cannot be fully excluded. Premenopausal women should be counseled accordingly.[6]

Rapid adoption in the US​

Mandelbaum et al. (2020), National Inpatient Sample 2001–2015: among women younger than 50 undergoing inpatient benign hysterectomy with ovarian conservation and no adnexal pathology, OS increased from 2.4% in 2001 to 58.4% by 2015. Most of the increase followed publication of the tubal hypothesis in 2010 (aOR 5.42 for the period after 2010; 95% CI 5.34–5.51).[17]

The magnitude of missed opportunity​

Moufarrij et al. (2025), JAMA Surg:[18]

  • Among 1,877 patients with HGSOC, 23.7% (445) had missed opportunities for salpingectomy: 54.2% had prior tubal ligation / hysterectomy without salpingectomy, and 45.8% had other abdominopelvic surgeries.[18]
  • A 43.2% missed-opportunity rate for germline genetic testing and reflex risk-reducing surgery was also identified among patients with an affected first-degree relative.[18]

Tischer et al. (2025): nearly 60% of patients with HGSOC had ≥1 prior abdominal or pelvic surgery where OS could have been performed, often decades before diagnosis (median 30 years). Among prior gynecologic index surgical episodes, tubal ligation was most common (98/297; 33%); among prior general-surgery episodes, cholecystectomy was most common (94/176; 53.4%).[19]

Part VIII: Expanding beyond gynecologic surgery​

Current guidance supports considering OS during selected non-gynecologic abdominopelvic procedures, but observed US inpatient uptake was rare in 2016–2020; the projected benefits below come from models.[6][41]

  • Cholecystectomy. Matsuo et al. (2023) cost-effectiveness model, which assumed a 65% risk reduction: OS at laparoscopic cholecystectomy was cost-effective (ICER $11,162–$26,463 / QALY) and prevented 30–39 ovarian-cancer cases per 5,000 women depending on age.[20] Wright et al. (2025), also assuming a 65% risk reduction, estimated that OS at 80% of cholecystectomies in women aged 40–44 would prevent 279 ovarian-cancer cases after 50 years of follow-up, and that OS at 40% of cholecystectomies in all women ≥40 would prevent 850 lifetime cases per annual cohort.[21]
  • Broader implementation. Adjei et al. (2026) cost-effectiveness analysis of OS during 6 common abdominopelvic procedures (laparoscopic hysterectomy, appendectomy, cholecystectomy, gastric bypass, hernia repair, colectomy) in a hypothetical cohort of 40-year-old average-risk patients: OS was incrementally cost-saving ($2,176 per procedure) with more QALYs gained, yielding $18.78 million in healthcare savings for the modeled annual cohort.[22]
  • Kather et al. (2025) modeled OS at any suitable abdominal surgery in Germany: it could reduce ovarian-cancer cases by 15.3% (compared with 5.5% with OS only at hysterectomy / sterilization), with an ICER of −€8,686 / QALY (cost-saving).[23]

Part IX: Salpingectomy vs. oophorectomy — key distinctions​

Salpingectomy (tube removal only) and oophorectomy (ovary removal) are distinct operations.

ConsiderationOpportunistic salpingectomyBilateral salpingo-oophorectomy (BSO)
Usual prevention settingAverage-risk patients who have completed childbearing and are already undergoing suitable surgeryGene-specific inherited risk or another ovarian indication
Cancer preventionLower tubo-ovarian cancer incidence in observational data; does not eliminate serous or other ovarian/peritoneal cancersSubstantial risk reduction in appropriately selected high-risk patients, with residual peritoneal risk
Hormone consequencesRetains ovaries; short-term reserve findings reassuring, long-term endpoints less certainCauses immediate menopause if premenopausal; bone, cardiovascular, sexual and symptom consequences require counseling
Hormone therapyNot required solely because tubes were removedAfter premenopausal risk-reducing BSO, offer HRT until about age 51 if there is no personal breast-cancer history or other contraindication: combined HRT with a uterus and estrogen-only HRT after hysterectomy. Liaise with the breast-cancer team before offering HRT after prior breast cancer.[29]
[1][2][5][6][24][29]

Part X: Salpingectomy with delayed oophorectomy (high-risk patients)​

For BRCA1/2 carriers, RRSO remains the established strategy. Salpingectomy with delayed oophorectomy remains under study, with equivalent protection unproven. Completion timing follows gene-specific guidance and needs cancer-team counseling:[8][9]

The lifetime ovarian-cancer risk that justifies these timelines: a prospective cohort of over 9,800 BRCA1/2 carriers, of whom 5,066 were eligible for the ovarian-cancer analysis, estimated cumulative risk to age 80 at 44% (95% CI 36–53%) for BRCA1 and 17% (95% CI 11–25%) for BRCA2.[33] Lynch syndrome also carries elevated ovarian-cancer risk; a French family-based study of 537 Lynch-syndrome families estimated cumulative risk to age 70 at 20% (95% CI 1–65%) for MLH1, 24% (95% CI 3–52%) for MSH2, and 1% (95% CI 0–3%) for MSH6 mutation carriers.[34] NICE lists hysterectomy with BSO for MLH1, MSH2, or MSH6 carriers no earlier than age 35 after specialist assessment, with earlier surgery considered after individual risk assessment.[29] For heterozygous PMS2 without an ovarian-cancer family history, hysterectomy alone may be considered from age 45; adding BSO depends on verified family history, age, and menopausal status.[29]

  • BRCA1. Recommend RRSO between ages 35–40.
  • BRCA2. Reasonable to delay RRSO until ages 40–45.
  • If salpingectomy is performed first, completion oophorectomy is recommended per gene-specific timelines.
  • SEE-FIM protocol and pelvic washings should be performed at salpingectomy.
  • Clinical trials of interval salpingectomy and delayed oophorectomy are ongoing, and strong consideration of study participation is recommended. In the nonrandomized TUBA preference study, 72/410 (17.6%) salpingectomy patients completed oophorectomy within five years; menopause-related quality of life was better while ovaries remained but similar to RRSO when the salpingectomy group included patients who had completed oophorectomy.[40]
  • Contraceptive counseling is separate from cancer prevention; a hormonal IUD is not an established substitute for gene-specific risk-reducing surgery.

The prevention benefits of salpingectomy alone are not established as equivalent to RRSO in high-risk patients, and patients remain at risk for developing ovarian cancer after salpingectomy without oophorectomy. NICE specifically restricts the delayed-oophorectomy strategy to clinical trials.[29]

Part XI: Management of incidental adnexal masses​

When an adnexal mass is encountered during surgery, ACOG Practice Bulletin No. 174 provides guidance:[25]

  • Observation depends on high-quality imaging, symptoms, menopause status, size, and cancer risk; a size of 10 cm is not a blanket reassurance threshold. RCOG updated guidance exempts asymptomatic, simple, unilateral, unilocular postmenopausal cysts ≤3 cm from routine follow-up; cysts >3 to ≤5 cm with the same features and normal CA125 can undergo repeat assessment in 4–6 months, while larger, symptomatic, or complex lesions require further evaluation.[31]
  • Minimally invasive surgery is preferred for presumed benign masses. A mass suspicious for malignancy warrants gynecologic-oncology consultation or referral before definitive adnexal management when feasible. If a malignant ovarian tumor is discovered incidentally during surgery, consult gynecologic oncology intraoperatively if possible and avoid cyst rupture or intraperitoneal spillage.[25]
  • Ovarian preservation is important in premenopausal patients when oncologically appropriate, including those who have completed childbearing. For a postmenopausal cyst requiring low-risk laparoscopic treatment, RCOG recommends salpingo-oophorectomy rather than cystectomy, usually bilateral after discussion with the patient.[31]
  • Aspiration of cyst fluid for diagnosis is contraindicated when malignancy is suspected, apart from selected advanced-cancer cases in which neoadjuvant therapy is planned; cytology sensitivity is 50–74%, and aspiration can cause peritoneal seeding.[25]
  • Adnexal torsion. Prompt detorsion and conservation are generally appropriate in young patients when feasible; a dark appearance alone does not establish irreversible loss of function.[25]

The IOTA5 prospective cohort supports surveillance of masses judged benign on ultrasound. Of 3,144 eligible conservatively managed patients, 2,587 had follow-up data; the newly diagnosed subgroup included 1,919. Its 2-year cumulative incidence was 0.4% invasive malignancy, 0.3% borderline tumor, 0.4% torsion, and 0.2% rupture.[26]

ACOG recommends that counseling for women undergoing routine pelvic surgery include:[1]

  1. The potential benefits of fallopian-tube removal for ovarian-cancer risk reduction.
  2. That OS significantly decreases but does not eliminate ovarian-cancer risk entirely.
  3. An informed-consent discussion about the role of oophorectomy and BSO, including that BSO causes surgical menopause and may increase risks of cardiovascular disease, other cancers, osteoporosis, cognitive impairment, and all-cause mortality.
  4. That ovarian function does not appear to be affected by salpingectomy based on surrogate serum markers.
  5. Discuss surgical approach, likelihood of completing salpingectomy, and incremental risk; the 2026 ACOG update withdraws its earlier advice not to change the route of surgery to facilitate salpingectomy and asks surgeons to disclose when an approach (eg, vaginal vs laparoscopic hysterectomy) may lower the likelihood of completing it.[28]
  6. For patients desiring permanent sterilization, the risks and benefits of salpingectomy compared with tubal ligation.

ESGO limits this intervention to patients who no longer want tubal fertility: counsel about permanent sterilization before surgery, with adequate time for consideration, and avoid proceeding through massive adhesions or other disproportionate risk. The ESGO adds that age alone should not be used to withhold OS, although data are insufficient to determine which age group benefits most.[6]

Summary — key principles​

  1. Rationale. Most HGSOC originates in the fimbriated end of the fallopian tube (STIC lesions), not the ovarian surface.[3][4]
  2. Risk reduction. Observational estimates vary by population and histology; avoid promising a fixed personal reduction.[6]
  3. Safety. Perioperative and short-term ovarian-reserve data are generally reassuring; operative time, feasibility, and longer-term uncertainty require counseling.[1][6][15]
  4. Indications. OS is considered for all eligible women undergoing gynecologic surgery and is expanding to non-gynecologic abdominopelvic procedures.[6][20][22]
  5. Technique. Complete salpingectomy extends from the fimbria to the uterotubal junction.[1] SEE-FIM pathologic processing is recommended for high-risk risk-reducing surgery; it is not an established routine requirement for average-risk opportunistic salpingectomy.[9][11][29]
  6. Missed opportunities. Two retrospective cohorts found qualifying prior surgical opportunities in 445/1,877 (23.7%) and 342/605 (56.5%) patients with HGSOC, respectively; their eligibility rules differed.[18][19]
  7. Salpingectomy differs from oophorectomy. OS preserves the ovaries and avoids surgical menopause, unlike BSO.[1][24]
  8. High-risk patients. Delayed oophorectomy is investigational.[8][9]
  9. Cost-effectiveness. Models project savings in selected settings; results depend on uptake, cancer-risk reduction, complication rates, and local costs.[22][23][27]

See Also​

References​

1. Chohan L, Richardson DL. Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention. American College of Obstetricians and Gynecologists; 2019.

2. American College of Obstetricians and Gynecologists. "ACOG Committee Opinion No. 774: opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention." Obstet Gynecol. 2019;133(4):e279–e284. doi:10.1097/AOG.0000000000003164

3. Pölcher M, Wimberger P, Meinhold-Heerlein I, et al. "Intergroup statement: opportunistic salpingectomy — molecular pathology, clinical outcomes and implications for practice (German Ovarian Cancer Commission, NOGGO, AGO Austria, AGO Swiss)." Arch Gynecol Obstet. 2025;311(5):1451–1459. doi:10.1007/s00404-025-07974-z

4. Sisodia RC, Del Carmen MG. "Lesions of the ovary and fallopian tube." N Engl J Med. 2022;387(8):727–736. doi:10.1056/NEJMra2108956

5. Kahn RM, Gordhandas S, Godwin K, et al. "Salpingectomy for the primary prevention of ovarian cancer: a systematic review." JAMA Surg. 2023;158(11):1204–1211. doi:10.1001/jamasurg.2023.4164

6. Piek JM, Schauwaert J, Ellis LB, et al. "Opportunistic Salpingectomy for Prevention of Tubo-Ovarian Carcinoma: The European Society of Gynaecological Oncology Consensus Statements." JAMA. 2026;335(10):894-902. doi:10.1001/jama.2025.24510

7. Duus AH, Zheng G, Baandrup L, Faber MT, Kjær SK. "Risk of ovarian cancer after salpingectomy and tubal ligation: prospects on histology and time since the procedure." Gynecol Oncol. 2023;177:125–131. doi:10.1016/j.ygyno.2023.08.016

8. National Comprehensive Cancer Network. Genetic / Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate. Updated 2026-02-19.

9. National Comprehensive Cancer Network. Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer. Updated 2026-04-10.

10. Eleje GU, Eke AC, Ezebialu IU, et al. "Risk-reducing bilateral salpingo-oophorectomy in women with BRCA1 or BRCA2 mutations." Cochrane Database Syst Rev. 2018;8:CD012464. doi:10.1002/14651858.CD012464.pub2

11. Samimi G, Trabert B, Duggan MA, et al. "Processing of fallopian tube, ovary, and endometrial surgical pathology specimens: a survey of US laboratory practices." Gynecol Oncol. 2018;148(3):515–520. doi:10.1016/j.ygyno.2018.01.016

12. Maryns AS, Hamerlynck T, van Overberghe C, et al. "Opportunistic salpingectomy: is surgical completeness achieved? Insights from the QOS study." Eur J Obstet Gynecol Reprod Biol. 2026;321:115066. doi:10.1016/j.ejogrb.2026.115066

13. Rufin KGA, do Valle HA, McAlpine JN, Elwood C, Hanley GE. "Complications after opportunistic salpingectomy compared with tubal ligation at cesarean section: a retrospective cohort study." Fertil Steril. 2024;121(3):531–539. doi:10.1016/j.fertnstert.2023.11.031

14. Mandelbaum RS, Matsuzaki S, Sangara RN, et al. "Paradigm shift from tubal ligation to opportunistic salpingectomy at cesarean delivery in the United States." Am J Obstet Gynecol. 2021;225(4):399.e1–399.e32. doi:10.1016/j.ajog.2021.06.074

15. Gelderblom ME, IntHout J, Dagovic L, et al. "The effect of opportunistic salpingectomy for primary prevention of ovarian cancer on ovarian reserve: a systematic review and meta-analysis." Maturitas. 2022;166:21–34. doi:10.1016/j.maturitas.2022.08.002

16. Hanley GE, Kwon JS, McAlpine JN, et al. "Examining indicators of early menopause following opportunistic salpingectomy: a cohort study from British Columbia, Canada." Am J Obstet Gynecol. 2020;223(2):221.e1–221.e11. doi:10.1016/j.ajog.2020.02.005

17. Mandelbaum RS, Adams CL, Yoshihara K, et al. "The rapid adoption of opportunistic salpingectomy at the time of hysterectomy for benign gynecologic disease in the United States." Am J Obstet Gynecol. 2020;223(5):721.e1–721.e18. doi:10.1016/j.ajog.2020.04.028

18. Moufarrij S, Hazimeh D, Rockwell T, et al. "Gauging the magnitude of missed opportunity for ovarian cancer prevention." JAMA Surg. 2025;160(10):1091-1098. doi:10.1001/jamasurg.2025.2810

19. Tischer KM, Islam NS, McGree ME, et al. "Quantifying opportunities to reduce high-grade serous ovarian cancer via opportunistic salpingectomy." Gynecol Oncol. 2025;203:165–170. doi:10.1016/j.ygyno.2025.10.028

20. Matsuo K, Chen L, Matsuzaki S, et al. "Opportunistic salpingectomy at the time of laparoscopic cholecystectomy for ovarian cancer prevention: a cost-effectiveness analysis." Ann Surg. 2023;277(5):e1116–e1123. doi:10.1097/SLA.0000000000005374

21. Wright JD, Chen L, Tymm C, et al. "Population-level reduction in ovarian cancer through performance of opportunistic salpingectomy at the time of cholecystectomy." Ann Surg. 2025. doi:10.1097/SLA.0000000000006940

22. Adjei NN, Yeh PG, Haas A, et al. "Opportunistic salpingectomy during gynecologic and non-gynecologic abdominopelvic procedures for ovarian cancer primary prevention: a cost-effectiveness analysis." Int J Gynecol Cancer. 2026;36(6):102884. doi:10.1016/j.ijgc.2025.102884

23. Kather A, Arefian H, Schneider C, Hartmann M, Runnebaum IB. "Ovarian cancer prevention through opportunistic salpingectomy during abdominal surgeries: a cost-effectiveness modeling study." PLoS Med. 2025;22(1):e1004514. doi:10.1371/journal.pmed.1004514

24. Adelman MR, Sharp HT. "Ovarian conservation vs removal at the time of benign hysterectomy." Am J Obstet Gynecol. 2018;218(3):269–279. doi:10.1016/j.ajog.2017.07.037

25. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. "Practice Bulletin No. 174: evaluation and management of adnexal masses." Obstet Gynecol. 2016;128(5):e210–e226. doi:10.1097/AOG.0000000000001768

26. Froyman W, Landolfo C, De Cock B, et al. "Risk of complications in patients with conservatively managed ovarian tumours (IOTA5): a 2-year interim analysis of a multicentre, prospective, cohort study." Lancet Oncol. 2019;20(3):448–458. doi:10.1016/S1470-2045(18)30837-4

27. Naumann RW, Hughes BN, Brown J, Drury LK, Herzog TJ. "The impact of opportunistic salpingectomy on ovarian cancer mortality and healthcare costs: a call for universal insurance coverage." Am J Obstet Gynecol. 2021;225(4):397.e1–397.e6. doi:10.1016/j.ajog.2021.03.032

28. American College of Obstetricians & Gynecologists Committee on Clinical Consensus–Gynecology. "Salpingectomy for the Prevention of Epithelial Ovarian Cancer." Clinical Practice Update. Obstet Gynecol. 2026;148(4):e275–e280. doi:10.1097/AOG.0000000000006400

29. NICE. Ovarian cancer: identifying and managing familial and genetic risk. NG241, 2024. Recommendations.

30. Sowamber R, Mei AJ, Kaur P, et al. "Serous Ovarian Cancer Following Opportunistic Bilateral Salpingectomy." JAMA Netw Open. 2026;9(2):e2557267. doi:10.1001/jamanetworkopen.2025.57267.

31. RCOG. The Management of Ovarian Cysts in Postmenopausal Women. Green-top Guideline34, amended December 2025. Guideline.

32. Subramaniam A, et al. "Feasibility of Complete Salpingectomy Compared With Standard Postpartum Tubal Ligation at Cesarean Delivery: A Randomized Controlled Trial." Obstet Gynecol. 2018. Primary trial.

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