Laparoscopic ovarian transposition prior to pelvic radiation for gynecologic cancer

Abstract

This study evaluates a novel technique of laparoscopic ovarian transposition performed by Gynecologic Oncologists prior to pelvic radiation for gynecologic cancer. A retrospective review was completed of all patients that underwent laparoscopic ovarian transposition from February 2007 to June 2017 at one tertiary care cancer. The technique involves salpingectomy, followed by retroperitoneal dissection to move the ovaries lateral to the hepatic and splenic flexures of the colon. Normal ovarian function was defined by the absence of vasomotor symptoms, FSH and menstrual history (if menstruating). The radiation dose to the ovary was calculated through dose volume histograms from three-dimensional image planning. Ten patients had laparoscopic ovarian transposition, of which, eight patients received post-operative external beam radiation to the pelvis (45–59.4 Gy). Four had additional brachytherapy (35.5–40 Gy). Median age and follow up were 29 years (18–37), and 20 months (6–103). Nine patients had cervical and one had vaginal cancer. Four patients were treated with primary radiation, three had radical trachelectomy with adjuvant radiation, and three had radical hysterectomy with one of three receiving adjuvant radiation. No patients developed vasomotor symptoms (0/8 (95% CI 0–19%)). FSH was normal in 2/2 patients. Menses continued post-radiation in 5/7 women who retained their uterus. The median radiation dose to the right and left ovary was 0.51 (0.23–1.1) Gy and 0.53 (0.23–1.1) Gy, respectively. Laparoscopic ovarian transposition with mobilization to the hepatic and splenic flexures of the colon achieves preservation of ovarian function in women prior to pelvic radiation.

Ovarian Function Preservation in Patients With Cervical Cancer Undergoing Hysterectomy and Ovarian Transposition Before Pelvic Radiotherapy

“…OT is a surgery to transpose the ovaries out of the field of radiation to protect them from radiation damage. 13 Hoekman et al 11 noted that the 5-year ovarian survival rate was 60.3% in patients who underwent OT before RT, whereas all patients who received RT without OT had an ovarian failure, which is similar to our study. The degree of ovarian damage and ovarian failure is affected by the radiation dose of ovaries.…”

Ovarian Function Preservation in Patients With Cervical Cancer Undergoing Hysterectomy and Ovarian Transposition Before Pelvic Radiotherapy

“…OT is a surgery to transpose the ovaries out of the eld of radiation to protect them from radiation damage [12]. Hoekman et al [11] noted that the 5-year ovarian survival rate was 60.3% in patients who underwent OT before RT, whereas all patients who received RT without OT had ovarian failure, which is similar to our study.…”

Laparoscopic and Robotic Surgery for Endometrial and Cervical Cancer

“…MIS can be used to carry out ovarian transposition in young women with cervical cancer who wish to conceive with the aid of assisted reproduction and surrogacy, thus enabling them to have genetically related children. Ovarian transposition has been described using open [114], laparoscopic [115] and robotic methods [116]. The preservation of ovarian function has been reported to be 65% in women who have had surgery followed by pelvic radiotherapy [114].…”

“…The preservation of ovarian function has been reported to be 65% in women who have had surgery followed by pelvic radiotherapy [114]. Higher rates of ovarian preservation have been described with techniques involving transposing the ovaries laterally to the hepatic and splenic flexures and thereby avoiding the pelvic radiation field [115]. The preservation of ovarian function does not directly translate into successful pregnancy outcomes [117].…”