Surgical opportunities for primary prevention of high-grade serous ovarian cancer: a procedure-level analysis of opportunistic salpingectomy

Abstract Background High-grade serous ovarian carcinoma (HGSOC), the most common and lethal subtype of epithelial ovarian cancer, is now recognized to originate predominantly from the distal fallopian tube. This paradigm shift has established opportunistic salpingectomy (OS) as a promising strategy for primary prevention during otherwise indicated abdominal or pelvic surgery. However, the frequency, timing, and surgical distribution of previous opportunities for OS among patients subsequently diagnosed with HGSOC remain insufficiently characterized. Objective To quantify previous surgical opportunities for OS before HGSOC diagnosis using complementary patient-level and procedure-level analyses. Methods This retrospective cohort study included patients with histologically confirmed HGSOC who underwent primary debulking surgery or interval debulking surgery after neoadjuvant chemotherapy between 2016 and 2025. Clinicopathological characteristics, family and personal cancer history, germline genetic testing results, and previous abdominopelvic procedures were reviewed. A procedure was considered eligible for OS if it was elective, had been performed at least 12 months before HGSOC diagnosis, and occurred after completion of childbearing. Results Among 426 patients, 165 (38.7%) had undergone at least one previous abdominal or pelvic operation that fulfilled the predefined eligibility criteria for OS. At the procedure level, 210/469 previous operations (44.8%) represented potential opportunities for OS. Of these, 112/210 (53.3%) were sterilization procedures and 98/210 (46.7%) were non-sterilization procedures. Gynecologic surgery accounted for 135/210 (64.3%) eligible procedures, whereas 75/210 (35.7%) occurred during non-gynecologic surgery. Hysterectomy was the most common gynecologic procedure, and cholecystectomy was the most frequent non-gynecologic procedure. Eligible procedures were performed at a median age of 46.0 years (IQR, 40.0–53.0) and preceded HGSOC diagnosis by a mean interval of 17.9 years. Among 116 genetically tested patients meeting the OS-eligibility criteria, 32 (27.6%) carried a pathogenic germline variant. Conclusion More than one-third of patients with HGSOC had at least one previous surgical opportunity during which OS could have been considered, nearly two decades before HGSOC diagnosis. Although gynecologic surgery remains the principal setting for implementing OS, more than one-third of eligible procedures occurred during non-gynecologic surgery. These findings highlight repeated opportunities for OS across surgical specialties and support broader multidisciplinary implementation of OS for the primary prevention of HGSOC.