Opportunistic salpingectomy during radical cystectomy for bladder cancer: A systematic review of the literature.

OBJECTIVE

Pelvic organ-sparing surgery aims to preserve vital reproductive and sexual organs, enhancing quality of life, especially in premenopausal women. Pelvic organ preservation for female patients undergoing radical cystectomy is now emphasized for sexual and hormonal function. Recent screening studies show no survival advantage despite early diagnosis of ovarian cancer, but opportunistic salpingectomy could reduce high-grade serous carcinoma risk. The aim of this review was to analyze the incidence of metachronous or delayed ovarian cancer in patients undergoing radical cystectomy for bladder cancer.

METHODS

PubMed, Scopus, Web of Science, ClinicalTrials.gov, and Cochrane Library were searched systematically for English-language articles up to June 2024. The selection was done first by title and abstract screening and then by full-text assessment for eligibility. This review has been registered in PROSPERO (CRD42024561902).

RESULTS

This review included two retrospective studies (2211 patients). Most patients had local or regional advanced disease, with a minority having distant disease. Only one study reported direct pelvic organ involvement from urothelial cancer, with no ovarian involvement found. Among patients who had organ-sparing surgery or pelvic exenteration, only two developed ovarian cancer post-surgery. No mean follow-up time or side effects from pelvic organ removal were reported in either study.

CONCLUSION

When oncologically safe, ovarian-sparing surgery with salpingectomy should be considered in female bladder cancer patients undergoing radical cystectomy. Opportunistic salpingectomy should be encouraged during abdominal urological surgeries, with thorough pre-operative counseling guiding decisions. Further studies are needed to define the role of preventive gynecologic surgery in urologic procedures.