Abstract
Introduction The aim of this study is to assess the prevalence of tubal histopathological abnormalities (serous tubal intraepithelial carcinoma STIC and p53 signatures) and the prevalence of perioperative and postoperative complications related to opportunistic laparoscopic salpingectomy in a low risk population. Materials and Methods In this observational prospective cohort, prophylactic bilateral salpingectomy during benign laparoscopic hysterectomy was systematically performed in 100 consecutive women. Peri- and postoperative complications were registered. Duration of salpingectomy and post-salpingectomy blood loss were also measured. Histopathological and immunohistochemical analysis with anti-p53 antibody were performed on the whole fallopian tubes according to a specific and validated protocol. Results Laparoscopic salpingectomy was always possible without any peri- or postoperative complication attributable to the salpingectomy itself. The mean duration was 428 seconds (354 – 596) and the blood loss was 9 cm 3 (2 – 15). Using histopathological and immunohistochemical assessment with anti-p53 antibody on 199 fallopian tubes (99 bilateral salpingectomies and one unilateral salpingectomy because of previous salpingectomy for ectopic pregnancy), there was a prevalence of 5.52% (11/199) of p53 signatures. No STIC were observed and no associated cancer. Conclusions Laparoscopic salpingectomy is both feasible and innocuous during benign hysterectomy. Meticulous histopathologic examination of the tubes may reveal specific abnormalities.
Highlights
The aim of this study is to assess the prevalence of tubal histopathological abnormalities and the prevalence of perioperative and postoperative complications related to opportunistic laparoscopic salpingectomy in a low risk population
It is presumed that the SCOUT lesions could develop into p53 signature and into STIC
Several series of non-genetic sporadic high-grade serous ovarian cancers were re-analysed and revealed the presence of the same tubal carcinogenic sequence. All these arguments would be in favour of the tubal origin of ovarian carcinogenesis and could lead to preventive surgical strategies as exclusive prophylactic salpingectomy without ovariectomy [1, 2]
Summary
The aim of this study is to assess the prevalence of tubal histopathological abnormalities (serous tubal intraepithelial carcinoma STIC and p53 signatures) and the prevalence of perioperative and postoperative complications related to opportunistic laparoscopic salpingectomy in a low risk population. Recent histopathological analyses of prophylactic salpingo-oophorectomies for genetic risk have revealed new occult precancerous lesions named Serous Tubal Intraepithelial Carcinoma or STIC. These lesions consist of nonciliated cells and are defined by the following features: epithelial stratification, nuclear atypias with an increase in the nucleocytoplasmic ratio, loss of nuclear polarity, nuclear pleiomorphism, loss of ciliated cells, intense and diffuse immunohistochemical expression of p53. Several series of non-genetic sporadic high-grade serous ovarian cancers were re-analysed and revealed the presence of the same tubal carcinogenic sequence All these arguments would be in favour of the tubal origin of ovarian carcinogenesis and could lead to preventive surgical strategies as exclusive prophylactic salpingectomy without ovariectomy [1, 2]
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