Highlight The primary disease and patient's age varied in FP for children and adolescents. New patient selection criteria for OTC will be needed accordance with development of technology. Revised patient selection criteria might be appropriate in a short observation period.

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Introduction The Laparoscopic Approach to Cervical Cancer (LACC) trial, a prospective randomized phase III clinical trial reported in 2018, unexpectedly showed inferior oncologic outcomes in laparoscopic radical hysterectomy (LRH) for cervical cancer compared with those in open surgery. It was proposed that the spillage of tumor cells into the peritoneal cavity might cause the inferiority of LRH. It has been suggested, based on retrospective studies, that transvaginal closure of the vaginal cuff before the colpotomy part of the surgery may prevent this. Materials and Surgical Technique Before starting colpotomy, we closed the vaginal cuff transvaginally. After the assessment of the cutline of the vagina, the vaginal mucosa is pulled at the eight sites using the sutures. The four pairs of sutures on the diagonal line are ligated. A purse string suture is additionally placed on the vaginal mucosa to close the vaginal cuff completely. After that, we start the intracorporeal colpotomy using a vaginal pipe. Discussion Our technique is simple and quick. The blood loss during the transvaginal procedures is minimal. The use of the vaginal pipe helps keep the vaginal cuff closed during the colpotomy. Our technique may be an alternative to the conventional approach closing the vaginal cuff.

Objectives: Medroxyprogesterone acetate (MPA) therapy is useful as a fertility-sparing treatment for early endometrial cancer, but it poses a risk of progression and recurrence during the treatment. We report a case of endometrial cancer with tubal metastases after long-term MPA therapy and review the literatures focusing on the failure of fertility-sparing treatment. Case: A nulliparous, 40 years old woman was started on MPA therapy after being diagnosed with grade 1 endometrioid carcinoma confined to the endometrium. She achieved complete remission after 10 months of treatment, but no pregnancy was established by assisted reproductive technology (ART). Eleven months after the first MPA therapy ended, atypical endometrial hyperplasia was confirmed. The disease was in remission again after the second MPA therapy for 8 months. The patient did not become pregnant by subsequent ART. Finally, a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed. The gross pathological specimen revealed a 13 mm mass near the left uterine cornu. Histopathology showed a left tube metastasis. She was diagnosed with FIGO stage IIIA endometrial cancer and underwent the staging surgery by laparotomy. After the second surgery, adjuvant chemotherapy was initiated. After 13 months of diseasefree survival, a recurrence was histologically detected at the vaginal stump. Following intracavitary radiation therapy, there was no evidence of disease for 10 months. Conclusions: The patient undergoing fertility-sparing treatment should be apprised of a risk of life-threatening progression of the disease. Once the patient has opted out of fertility preservation, definitive hysterectomy should be strongly recommended.

ObjectiveTo verify understanding and awareness of fertility preservation (FP) in pediatric patients undergoing FP treatments.MethodsA questionnaire survey was conducted before and after explanation of fertility issues and FP treatments for patients 6–17 years old who visited or were hospitalized for the purpose of ovarian tissue cryopreservation (OTC) or oocyte cryopreservation (OC), or sperm cryopreservation between October 2018 and April 2022. This study was approved by the institutional review board at St. Marianna University School of Medicine (No. 4123, UMIN000046125).ResultParticipants in the study comprised 36 children (34 girls, 2 boys). Overall mean age was 13.3 ± 3.0 years. The underlying diseases were diverse, with leukemia in 14 patients (38.9%), brain tumor in 4 patients (11.1%). The questionnaire survey before the explanation showed that 19 patients (52.8%) wanted to have children in the future, but 15 (41.7%) were unsure of future wishes to raise children. And most children expressed some degree of understanding of the treatment being planned for the underlying disease (34, 94.4%). Similarly, most children understood that the treatment would affect their fertility (33, 91.7%). When asked if they would like to hear a story about how to become a mother or father after FP which including information of FP, half answered “Don’t mind” (18, 50.0%). After being provided with information about FP treatment, all participants answered that they understood the adverse effects on fertility of treatments for the underlying disease. Regarding FP treatment, 32 children (88.9%) expressed understanding for FP and 26 (72.2%) wished to receive FP. “Fear” and “Pain” and “Costs” were frequently cited as concerns about FP. Following explanations, 33 children (91.7%) answered “Happy I heard the story” and no children answered, “Wish I hadn’t heard the story”. Finally, 28 of the 34 girls (82.4%) underwent OTC and one girl underwent OC.DiscussionThe fact that all patients responded positively to the explanations of FP treatment is very informative. This is considered largely attributable to the patients themselves being involved in the decision-making process for FP.ConclusionsExplanations of FP for children appear valid if age-appropriate explanations are provided.