Laparoscopic ovarian transposition in teenage and young women with locally advanced rectal cancer: Respite amidst cancer chaos

Abstract

Aim Ovarian transposition is an established surgical technique to salvage ovaries in premenopausal women requiring pelvic radiation. The success rate of ovarian transposition varies widely depending on the route, technique of surgery, type of cancer and treatment. Here, we aimed to analyse the effectiveness of laparoscopic ovarian transposition (LOT) in teenage and young women prior to pelvic radiation in locally advanced rectal cancers (LARC). Methods Patients who underwent LOT for rectal cancers were retrieved from a prospectively maintained database from June 2013–September 2019. Disease characteristics, return of menstrual function and oncological outcomes were analysed. Results A total of 46 women with a mean age of 25.2 years who underwent LOT at the cancer centre were included in the study. Seventy percent were nulliparous. All patients were fit for discharge by 24 h. Mean time to start radiation was 19.6 days (range 3–47 days). Median follow‐up of patients was 42 months. A total of 41 patients were assessable for ovarian function, 65.5% had resumption of menses. Median ovarian survival was 79 months and 5‐year ovarian survival was 54%. Median overall survival from rectal cancer was 51 months. Conclusion Laparoscopic ovarian transposition is a safe and effective technique of ovarian protection from the gonadotoxic effects of pelvic radiation in LARC. It does not delay primary treatment and does not compromise oncological outcomes. Long‐term follow‐up is required to evaluate fertility and quality of life.

Ovarian transposition in young women with locally advanced rectal cancer – is there evidence for harm?

“…The incidence of ovarian metastasis in our study was 17% at a median follow-up of 42 months. The majority of the failures, however, occurred in signet ring cell cancers (five of eight ovarian relapses); only one patient had isolated ovarian metastasis while the rest were accompanied by concomitant distant or peritoneal recurrences [1].…”

“…Recently, our group published the results of laparoscopic ovarian transposition (LOT) in locally advanced rectal cancers (LARC) that required preoperative pelvic irradiation [1]. Median ovarian survival was 76 months and only one patient developed isolated ovarian metastasis after 23 months that required a surgical salvage.…”

“…The incidence of ovarian metastasis in our study was 17% at a median follow‐up of 42 months. The majority of the failures, however, occurred in signet ring cell cancers (five of eight ovarian relapses); only one patient had isolated ovarian metastasis while the rest were accompanied by concomitant distant or peritoneal recurrences [1]. Thus, the attributable harm by transposing the ovaries appears to be small in nonsignet ring cell cancers and in signet ring cancers it needs to be studied whether irradiating the ovaries would have prevented peritoneal and systemic recurrences.…”