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The forgotten fallopian tube

Nature Reviews Cancer volume 11, page 227 (2011)Cite this article

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In David D. L. Bowtell's recent Opinion article (The genesis and evolution of high-grade serous ovarian cancer. Nature Rev. Cancer 10, 803–808 (2010))1, a considerable body of evidence is presented which further supports the central role of the fallopian tube in the pathogenesis of this disease. The hypothesis that a substantial proportion of high-grade serous ovarian cancers (HG-SOC) arise from the distal fallopian tube has also been proposed by several other unrelated investigations2,3,4,5,6,7,8,9. We think that these findings made by molecular geneticists and pathologists should now be translated into clinical practice. The immediate consequence for preventive medicine would be the easy-to-carry out simultaneous removal of the fallopian tubes during surgery, such as hysterectomy (removal of the uterus) or sterilization (coagulation or partial resection of the fallopian tubes). Sparing the fallopian tubes during hysterectomy provides no known physiological benefits, as the remaining tubes are completely devoid of any function. As the blood supply to the ovaries is secured through vessels from the infundibulopelvic ligament, it is not affected when hysterectomy is combined with bilateral removal of the fallopian tubes (salpingectomy). The hormone profile is not altered by salpingectomy, even several months after surgery10. The blind ending remnants of the tubes can provide a nidus for bacteria and thereby increase infectious morbidity and tubal pathology that can require further surgery11. However, in the light of recent findings, as discussed in Bowtell's article, the strongest reason for bilateral salpingectomy or fimbriectomy along with hysterectomy or sterilization is the potential role of the fallopian tube in the pathogenesis of HG-SOC. This disease accounts for the largest proportion of ovarian cancers and for about two-thirds of ovarian cancer-related deaths.

Such a revised strategy would clearly represent a paradigm change in preventive surgery. Until recently, all debates on the aetiology and prevention of ovarian cancer have focussed on the ovaries, whereas the fallopian tube was largely forgotten. Now, it is becoming clear that clinicians must pay due attention to the fallopian tube. Thus, simultaneous risk-reducing salpingectomy should become the new standard whenever a hysterectomy needs to be carried out.

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  1. Johannes Dietl and Jörg Wischhusen are at the Department for Obstetrics and Gynaecology, Julius-Maximilians-University Würzburg, School of Medicine, Josef-Schneider-Str. 4, 97080 Würzburg, Germany.,

    Johannes Dietl & Jörg Wischhusen

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Correspondence to Johannes Dietl.

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Dietl, J., Wischhusen, J. The forgotten fallopian tube. Nat Rev Cancer 11, 227 (2011). https://doi.org/10.1038/nrc2946-c1

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