Oophorectomy and Salpingectomy

Oophorectomy is the surgical removal of an ovary, and salpingectomy is the surgical removal of a fallopian tube; when both are removed together the operation is a salpingo-oophorectomy. These procedures are performed for ovarian and tubal disease, as part of cancer surgery, for risk reduction in people with a high hereditary cancer risk, and — increasingly — opportunistically to lower future ovarian cancer risk.

Definition

Oophorectomy is the surgical removal of one or both ovaries; salpingectomy is the surgical removal of one or both fallopian tubes; bilateral salpingo-oophorectomy removes both tubes and both ovaries together.

Scope

This topic covers the definitions of oophorectomy and salpingectomy, the distinction between unilateral and bilateral procedures, their main indications, and the systemic consequences of removing the ovaries. It also notes the rationale for opportunistic salpingectomy. It is a reference entry and does not provide individualized surgical advice.

Core questions

• When are the ovaries and tubes removed rather than conserved during gynecologic surgery?
• What are the systemic consequences of removing both ovaries, especially before menopause?
• What is the rationale for opportunistic salpingectomy to reduce ovarian cancer risk?

Key concepts

• Unilateral versus bilateral procedures
• Salpingo-oophorectomy
• Surgical (induced) menopause
• Risk-reducing surgery in hereditary cancer syndromes
• Opportunistic salpingectomy
• Ovarian conservation

Mechanisms

Removing an ovary or tube interrupts the structure's blood supply and excises it; removing both ovaries eliminates the principal source of endogenous oestrogen and, in a premenopausal person, produces an abrupt surgical menopause. The fallopian tube has emerged as a likely site of origin for many high-grade serous ovarian cancers, which is the biological basis for opportunistic salpingectomy — removing the tubes while conserving the ovaries during another pelvic operation — as a strategy to reduce future ovarian cancer risk without inducing menopause (Runnebaum et al., 2022). Decisions about ovarian removal therefore weigh disease control against the long-term effects of oestrogen loss (Parker et al., 2013).

Clinical relevance

Whether to remove or conserve the ovaries is a distinct decision from removing the uterus, with consequences for menopause, bone, and cardiovascular health that depend strongly on age. This entry describes the procedures and the evidence informing them and is not a basis for individual surgical decisions, which require a clinician's assessment of cancer risk, age, and goals.

Epidemiology

Bilateral oophorectomy has historically been performed at the time of hysterectomy in many older women on the rationale of preventing later ovarian cancer. Long-term cohort follow-up in the Nurses' Health Study found that, across the whole cohort, ovarian conservation was associated with lower long-term all-cause mortality than oophorectomy, prompting reassessment of routine ovary removal in lower-risk women (Parker et al., 2013).

History

Removal of the ovaries was among the earliest abdominal operations and was later combined routinely with hysterectomy to prevent ovarian cancer. Long-term cohort evidence on the mortality consequences of oophorectomy, together with the tubal-origin model of serous ovarian cancer, shifted practice toward ovarian conservation in lower-risk patients and toward opportunistic salpingectomy (Parker et al., 2013; Runnebaum et al., 2022).

Debates

Should the ovaries be removed at hysterectomy for benign disease?

Routine bilateral oophorectomy was once common to prevent ovarian cancer, but long-term cohort data link ovarian conservation to lower overall mortality in average-risk women, so prophylactic removal is now reserved more selectively for those at elevated cancer risk.

Should the tubes be removed opportunistically?

Because many ovarian cancers appear to arise in the fallopian tube, removing the tubes while conserving the ovaries during other pelvic surgery is proposed as a risk-reducing strategy that avoids surgical menopause, though long-term outcome data are still maturing.

Seminal works

• parker-2013
• runnebaum-2022

Frequently asked questions

What is the difference between oophorectomy and salpingectomy?

Oophorectomy removes an ovary, while salpingectomy removes a fallopian tube. When both an ovary and its tube are removed together the operation is called a salpingo-oophorectomy; this can be done on one side (unilateral) or both sides (bilateral).

Why are the tubes sometimes removed but the ovaries left in place?

Many ovarian cancers are now thought to originate in the fallopian tube, so removing the tubes (opportunistic salpingectomy) during another pelvic operation may reduce future ovarian cancer risk while conserving the ovaries and avoiding a surgically induced menopause.