Hysterectomy and OPPortunistic SAlpingectomy (HOPPSA)

HOPPSA is a register based randomized controlled trial (R-RCT), with the objective to examine if opportunistic salpingectomy compared with no salpingectomy, at the time of hysterectomy for a benign reason has no increased risk of complications has no negative side effects on ovarian function and subsequent cardiovascular disease or incidence of fractures implies reduced risk of subsequent ovarian cancer Randomization and follow-up will be conducted within national registers.

High grade serous ovarian cancer, the most fatal subtype, may originate in the fimbriae of the Fallopian tubes. This theory has led to the idea of opportunistic salpingectomy as a way of decreasing the risk of epithelial ovarian cancer (EOC). HOPPSA is a national register-based RCT, with randomization and follow-up in The Swedish National Quality Register of Gynecological Surgery (Gyn/Op). HOPPSA aims to study if opportunistic salpingectomy is safe, and if it can reduce the risk of EOC. PICO P (patients). Women <55 years, undergoing hysterectomy due to a benign reason I (intervention). Bilateral salpingectomy at the time of hysterectomy C (comparison). No salpingectomy O (outcomes). Primary short term: surgical complications reported according to Clavien-Dindo at 8 weeks post-operatively Intermediate term: change in menopausal symptoms from baseline to 1 year, assessed with Menopause Rating Scale Long term: ovarian cancer assessed through the National Cancer Register Recruitment of 4400 patients is estimated to take 4-6 years depending on the participation rate of the Swedish gynecological clinics. Data retrieval from GynOp on short and intermediate term outcomes, requiring smaller sample sizes, will be done at the end of the recruitment period. If these results, ready available when the study recruitment is closed, show that opportunistic salpingectomy does not increase surgical complications and menopausal symptoms, women can be advised to undergo salpingectomy to potentially minimize the future risk of EOC.

The intervention is a routine salpingectomy, performed laparoscopically, through laparotomy or vaginally.

Dichotomous outcome, retrieved from any of two sources in the GynOp register: specified question on complications and the Clavien-Dindo classification

The outcome is dichotomous, the diagnosis is classified according to ICD10. Each case with a positive outcome is further described with histopathological types and grade, as well as clinical stage according to International Federation of Gynecology and Obstetrics (FIGO). Assessed through national registers stage according to International Federation of Gynecology and Obstetrics (FIGO). Assessed through national registers

Assessment will be done at discharge from hospital after surgery, including a period up to 8 weeks. a

Prevalence of menopausal symptoms of at least moderate level according to Menopause Rating Scale (MRS)

Inclusion Criteria: Planned hysterectomy for a benign reason Age < 55 years at randomization Willing to be randomized Vaginal route may be included if the surgeon is confident with performing vaginal salpingectomy. Exclusion Criteria: Previous bilateral oophorectomy and/or salpingectomy Planned oophorectomy and/or salpingectomy (for reasons such as already diagnosed adnexal tumor, known carrier of the breast cancer susceptibility gene (BRCA) 1/2 mutation or Lynch syndrome (hereditary nonpolyposis colorectal cancer)) Non-understanding of the oral or written study information