Podcast Summary: Dr. Chapa’s OBGYN Clinical Pearls

Episode: OPS vs RRS: April 2026 AJOG
Date: April 1, 2026
Host: Dr. Chapa

Episode Overview

In this highly informative and engaging episode, Dr. Chapa dissects the crucial differences between Opportunistic Salpingectomy (OPS) and so-called Risk Reducing Salpingectomy (RRS), focusing on the new April 2026 Clinical Opinion published in the American Journal of Obstetrics & Gynecology. The episode aims to clarify confusing terminology, outline evidence-based recommendations, and provide practical, actionable advice for clinicians counseling patients about ovarian cancer risk reduction. Dr. Chapa highlights key studies, major organizational guidelines, and delivers four clear distinctions between OPS and RRS, emphasizing why precise language and correct patient counseling are imperative.

Key Discussion Points & Insights

1. The OPS vs. RRS Confusion

• Main Importance:
  • OPS (Opportunistic Salpingectomy) and RRS (Risk Reducing Salpingectomy) are often used interchangeably, but they are not the same in definition, use, or evidence base.
• Why It Matters:
  • Understanding these terms affects clinical recommendations, patient counseling, and ultimately, patient outcomes.

"Our words matter and more importantly, our actions matter...there are four big differences between opportunistic salpingectomy and risk reducing salpingectomy."
— Dr. Chapa [00:45]

2. Historical Context: The Science Driving Practice Change

• 2007 Crum Publication:
  • Revolutionized the understanding of the origin of epithelial ovarian cancer, revealing it commonly begins in the distal fallopian tube (fimbriae) —not the ovary.
• CFIM Protocol:
  • When performing OPS, pathologists must use the Sectioning and Extensively Examining the FIMbriated end (SEE-FIM) protocol to detect early lesions.
• Clinical Implication:
  • Key to correct specimen handling and diagnosis for all OPS cases.

"So remember this key term...CFIM protocol...Sectioning and Extensively Examining the Fimbrial End."
— Dr. Chapa [05:05]

3. OPS: General Population, Proven Benefit, Guideline-Endorsed

• Definition:
  • OPS targets the general population, performed at the time of another surgery (hysterectomy, C-section, etc.) or for sterilization, aiming to reduce epithelial ovarian cancer risk.
• Evidence:
  • Falconer (2015, JNCI): Bilateral salpingectomy leads to a 65% reduction in ovarian cancer risk (vs. 28% reduction with tubal ligation).
  • Practice Shift:
    • Marked increase in total salpingectomy rates since 2014-2015, now surpassing traditional tubal ligation for sterilization in the U.S.
• Guidelines:
  • Endorsed by ACOG (Committee Opinion 774), FIGO, NCCN.

"So yes, let me just say it right here. Tubal ligation still is protective. However, it's not the most protective...the preferred method for postpartum sterilization is the salpingectomy."
— Dr. Chapa [09:00, 11:44]

• Key Practical Advice:
  • Always offer OPS when fertility is complete, especially "if the tubes are accessible and she's dealing with fertility."
  • General surgeons should consider OPS during unrelated abdominal procedures where feasible.

4. RRS: High-Risk Populations, No Standalone Role for Tube Removal

• Definition & Target Population:
  • Intended for patients with germline high-risk mutations (primarily BRCA1/2, Lynch syndrome).
• Current Standard:
  • The ONLY proven risk-reducing approach is age-appropriate bilateral salpingo-oophorectomy (removal of tubes AND ovaries).
• Timing:
  • BRCA1: ages 35–40; BRCA2: ages 40–45.
  • Lynch: depends on exact gene mutation; sometimes allows for staging, but tube-only removal (RRS) is rarely sufficient outside specific scenarios (e.g., MSH6 mutation may delay oophorectomy until age 50).
• Guideline Stand:
  • No major guideline endorses isolated salpingectomy (RRS) for these patients outside of research trials.

"In high risk patients, just taking away the tubes is not a thing. RRS is actually not a thing."
— Dr. Chapa [18:20]

5. April 2026 AJOG Clinical Opinion: The Consensus

• Key Message:
  • Removing only the tubes (RRS) in high-risk women can falsely reassure and miss the window to prevent tubo-ovarian cancer.
• Notable Quote:

  “Their performance in standard clinical practice without careful counseling may falsely reassure high risk patients and lead to missed opportunities for tubo ovarian cancer prevention among those at the highest risk.”
  — Dr. Chapa quoting AJOG Clinical Opinion [21:40]

• Practical Takeaway:
  • For high-risk women, do not substitute OPS or RRS for full ovaries+ tubes removal (unless in a clinical trial).
  • Always provide thorough, nuanced counseling.

6. The Four Key Differences Between OPS and RRS

[23:08] Dr. Chapa’s concise summary:

1. Target Populations:

   • OPS: General population
   • RRS: High-risk population (germline mutation carriers)

2. Efficacy Evidence:

   • OPS: Proven effective (population-level risk reduction)
   • RRS: No evidence of efficacy as a standalone procedure

3. Endorsement:

   • OPS: Endorsed by ACOG, FIGO, NCCN
   • RRS: Not guideline-endorsed

4. Implementation:

   • OPS: Offer during other index surgeries
   • RRS: Only in context of research trials or in conjunction with oophorectomy (and possibly hysterectomy for Lynch syndrome)

“OPS is absolutely not the same thing as RRS because RRS is not enough in high risk individuals.”
— Dr. Chapa [24:14]

Notable Quotes & Memorable Moments

• “Our words matter, and more importantly, our actions matter.” — Dr. Chapa [00:45]
• “OPS is a thing. RRS actually is not a thing.” — Dr. Chapa [18:20]
• “If you’re going to do a postpartum tubal, please do a complete salpingectomy. It’s much lower failure rate and it’s much better for the patient in terms of more bang for her buck.” — Dr. Chapa [11:44]
• AJOG Clinical Opinion, April 2026:
  “Their performance in standard clinical practice without careful counseling may falsely reassure high-risk patients and lead to missed opportunities for tubo ovarian cancer prevention among those at the highest risk.” — [21:40 reading]

Timestamps for Important Segments

• 00:45 — Introduction: Why the terminology matters
• 05:00 — CFIM protocol and the 2007 Crum publication
• 08:30 — Swedish population risk reduction data (Falconer)
• 09:00 — Tubal ligation vs. salpingectomy: risk reduction discussion
• 13:31 — Practice trend: salpingectomy over tubal ligation in the U.S.
• 15:47 — BRCA and Lynch: High-risk patient protocols
• 18:20 — RRS is not endorsed — reasons explained
• 21:40 — AJOG Clinical Opinion quote on high-risk patient counseling
• 23:08 — The four major differences between OPS and RRS (summary)

Tone & Communication Style

Dr. Chapa maintains an enthusiastic, conversational, and highly practical tone throughout. Complex scientific evidence is distilled into memorable teaching points and clear, actionable recommendations reflecting his mission to make medical education “engaging and FUN.”

Summary Takeaway

• OPS (Opportunistic Salpingectomy):

  • PROVEN risk reduction for ovarian cancer in the general population
  • Endorsed by all major guidelines
  • Should be performed when feasible, especially during other surgeries

• RRS (Risk Reducing Salpingectomy):

  • Not evidence-backed as a standalone for BRCA/Lynch
  • No major guideline supports it—tube removal alone is inadequate for high risk
  • For high-risk patients, standard remains age-appropriate removal of both tubes AND ovaries

• Key Action for Practitioners:

  • Use language and recommendations carefully
  • Educate and counsel patients based on current evidence and guidelines
  • Stay up to date with clinical opinions and remember the critical difference between OPS and RRS

For the practicing OB/GYN, the distinction between OPS and RRS is not just academic—it directly affects clinical decisions and the welfare of your patients.