Objective To compare the clinical outcomes and beneficiary populations of prophylactic risk-reducing salpingo-oophorectomy (RRSO) for patients at high risk of ovarian cancer with those of opportunistic salpingo-oophorectomy (OS) due to other gynecological diseases. Methods This retrospective study involved 105 patients who underwent prophylactic resection (bilateral appendixes) at the Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, from March 2020 to September 2023. Baseline clinical information, including preoperative CA125 levels and imaging findings, postoperative pathology, and immunohistochemical results were collected and analyzed. Results Among the 25 patients who completed homologous recombination deficiency (HRD)-related genetic testing, 20 carried pathogenic mutations in homologous recombination repair (HRR) pathway genes. Twenty-four patients underwent SEE-FIM (Sectioning and Extensively Examining the FIMbriated end) protocol sampling, and 4 were diagnosed with high-grade serous ovarian carcinoma (HGSC). In contrast, none of the 80 patients who underwent OS due to other gynecologic conditions were diagnosed with malignancy. Conclusions Genetic counseling and timely RRSO are recommended for individuals carrying pathogenic BRCA1/2 mutations, as RRSO can effectively reduce the incidence of ovarian cancer. The timing of surgery will affect the final beneficiary populations