Does risk-reducing bilateral salpingo-oophorectomy leave behind residual tube?

OBJECTIVE

Risk-reducing bilateral salpingo-oophorectomy (RRSO) is an effective option for women with BRCA mutations however there is limited information as to how much tubal epithelium remains after RRSO.

METHODS

Twenty hysterectomy specimens were prospectively evaluated after both tubes were fulgurated and transected at the uterine cornua in an attempt to remove the complete fallopian tube simulating the RRSO procedure. Unfixed specimens were processed by a single pathologist who took sequential 3 mm cross sections perpendicular to the long axis of each residual tube beginning at the tubal resection line (or uterine cornua if prior adnexectomy) proceeding toward the uterine cavity. The presence and length of residual tube was recorded and sections were examined for preserved tubal epithelium. For each case with residual tube, the surface area of residual epithelium was calculated.

RESULTS

A tubal remnant was identified in 29 of 40 (73%) uterine cornual sites. The median length of residual tube was 6 mm (range 3-21 mm). Each tubal remnant had some preserved columnar epithelium. The median surface area of tubal remnant was 14 mm(2) (range 2-117 mm(2)). Prior adnexectomy did not affect the frequency of having a tubal remnant or the length of remnant tube. Neither menopausal status, indication for hysterectomy nor type of hysterectomy correlated with presence of residual tube.

CONCLUSION

The majority of the uterine cornua had a tubal remnant which suggests that RRSO may leave behind residual tubal epithelium. The clinical significance of this tubal remnant is unclear given the current understanding of tubal carcinogenesis.