Ovarian management at the time of radical hysterectomy for cancer of the cervix

Owens, Sheri; Roberts, William S.; Fiorica, James V.; Hoffman, Mitchel S.; LaPolla, James P.; Cavanagh, Denis

doi:10.1016/0090-8258(89)90077-2

Cited by 48 publications

(18 citation statements)

References 13 publications

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“…If OT takes place at the time of an extensive surgery, the risk for vascular compromise to the ovary from trauma or RH should be higher. Yet, the incidence of ovarian failure appears to be related to the length of follow up with 7% failing within 3 years and up to 50% within 5 years [22]. We noted that mean follow up in group B was shorter compared to group A, which might be partly responsible for the performance of the BR group.…”

Section: Discussionmentioning

confidence: 95%

Outcomes of ovarian transposition in gynaecological cancers; a systematic review and meta-analysis

et al. 2014

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BackgroundPelvic irradiation is essential for improving survival in women with pelvic malignancies despite inducing permanent ovarian damage. Ovarian transposition can be performed in premenopausal women in an attempt to preserve ovarian function. As uncertainty occurs over the proportion of women who are likely to benefit from the procedure, we performed a systematic review and meta-analysis of the proportion of women with ovarian function preservation, symptomatic or asymptomatic ovarian cysts and metastatic ovarian malignancy following ovarian transposition.MethodsMedline, Embase and The Cochrane Library databases were systematically searched for articles published from January 1980 to December 2013. We computed the summary proportions for ovarian function preservation, ovarian cyst formation and metastatic ovarian disease following ovarian transposition by random effects meta-analysis with meta-regression to explore for heterogeneity by type of radiotherapy.ResultsTwenty four articles reporting on 892 women undergoing ovarian transposition were included. In the surgery alone group, the proportion of women with preserved ovarian function was 90% (95% CI 92–99), 87% (95% CI 79–97) of women did not develop ovarian cysts and 100% (95% CI 90–111) did not suffer metastases to the transposed ovaries. In the brachytherapy (BR) ± surgery group, the proportion of women with preserved ovarian function was 94% (95% CI 79–111), 84% (95% CI 70–101) of women did not develop ovarian cysts and 100% (95% CI 85–118) did not suffer metastases to the transposed ovaries. In the external beam radiotherapy (EBRT) + surgery ± BR group, the proportion of women with preserved ovarian function was 65% (95% CI 56–74), 95% (95% CI 85–106) of women did not develop ovarian cysts and 100% (95% CI 90–112) did not suffer metastases to the transposed ovaries. Subgroup meta-analysis revealed transposition to the subcutaneous tissue being associated with higher ovarian cyst formation rate compared to the “traditional” transposition.ConclusionOvarian transposition is associated with significant preservation of ovarian function and negligible risk for metastases to the transposed ovaries despite common incidence of ovarian cysts.

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Section: Discussionmentioning

confidence: 95%

Outcomes of ovarian transposition in gynaecological cancers; a systematic review and meta-analysis

et al. 2014

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“…However, it has been reported a higher risk of unsuspected microscopic ovarian metastases in cases of adenocarcinoma (23–25) . As a matter of fact, the histologic type of the tumor is the most debated risk factor for ovarian metastasis, and some authors do not recommend ovarian transposition in adenocarcinomas (23–25) , while others consider that the histologic type does not matter (26,27) . In the largest study focusing on this issue by Sutton et al (28) for the Gynecologic Oncology Group, the rate of ovarian metastasis was not significantly correlated to tumor histologic type.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic ovarian transposition in patients with early cervical cancer

Pahisa

Martínez‐Román

Martínez-Zamora

et al. 2008

International Journal of Gynecological Cancer

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The aim of this study was to evaluate the feasibility, efficacy, and morbidity of laparoscopic ovarian transposition on the preservation of hormonal function in patients younger than 45 years operated for early cervical cancer. According to risk factors on pathologic evaluation of the specimen, some of them will receive postoperative pelvic radiotherapy. This subset of patients could benefit from taking the ovaries away from the irradiation field in an effort to preserve their functionality. This prospective study included 28 FIGO stage IB1 cervical cancer patients, 45 years old or younger, maintaining menstrual cycles, who were considered suitable for conservation of the ovaries. The ovarian transposition was performed by laparoscopy as a part of the same celio-Schauta operation. Twelve patients underwent adjuvant pelvic radiotherapy. No intraoperative or postoperative morbidity related to the ovarian transposition was observed, and the procedure only entailed a minimum delay of the operative time. There were no cases of ovarian metastasis. At a mean follow-up of 44 months, 63.6% of patients receiving radiotherapy and 93% of those who nonirradiated maintained normal ovarian function. Two patients developed benign ovarian cysts, requiring oophorectomy, but no other long-term adverse effects of the transposition were identified. To the best of our knowledge, this is the largest series of the laparoscopic procedure reported to date in this setting. According to our results, laparoscopic ovarian transposition is a safe and effective procedure for the preservation of ovarian function in young patients with early cervical cancer undergoing adjuvant radiotherapy after surgery.

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“…Despite OT, some women still suffer from ovarian failure after pelvic radiation. It has been shown that, due to scattered radiation, a substantial loss of ovarian function might still occur despite OT [ 21 , 24 , 40 ]. Furthermore, POI after OT and radiation therapy can be caused by migration of the ovaries back into the small pelvis after OT.…”

Section: Discussionmentioning

confidence: 99%

Ovarian survival after pelvic radiation: transposition until the age of 35 years

Hoekman

Knoester

Peters

et al. 2018

Arch Gynecol Obstet

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PurposeTo evaluate the effectiveness of ovarian transposition (OT) prior to radiation therapy (RT) and to evaluate the effect of age on ovarian survival (OS) after OT.MethodsWe performed a retrospective control study, with women (aged < 45 years) who underwent OT prior to pelvic radiation, versus women diagnosed with cervical cancer and treated with hysterectomy/trachelectomy and radiation therapy. All women were treated between 1989 and 2010. The 5 years OS rate was calculated, with a sub-analysis for age (25–30; 31–35 and 36–40 years). Ovarian failure was defined as climacteric complaints (with or without starting hormone replacement therapy) and/or laboratory measurements (FSH > 40 IU/L and/or estradiol < 100 pmol/L), or bilateral salpingo oophorectomy. Women were censored at recurrence.ResultsTwenty-seven women after OT and 29 controls were included. The radiation dose was 44.8 Gy (25.0–63.0 Gy) and 46.3 Gy (45.0–50.0 Gy), respectively. The 5-year ovarian survival rate was 60.3% versus controls 0% (p < 0.001 95% CI 3.48–11.50). Despite the decrease in ovarian survival after OT with increasing age, in all age groups (25–30, 30–35 and 35–40) ovarian survival after OT was significantly better compared to women without OT (p = 0.001; p = 0.004 and p = 0.000, respectively). Neither intra-vaginal radiation therapy of concomitant chemotherapy in addition to pelvic radiation significantly altered ovarian survival.ConclusionsOur data shows that ovarian transposition prior to pelvic radiation is effective in women until the age of 35 years and needs to be discussed in patients aged 36–40 years.

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Ovarian management at the time of radical hysterectomy for cancer of the cervix

Cited by 48 publications

References 13 publications

Outcomes of ovarian transposition in gynaecological cancers; a systematic review and meta-analysis

Outcomes of ovarian transposition in gynaecological cancers; a systematic review and meta-analysis

Laparoscopic ovarian transposition in patients with early cervical cancer

Ovarian survival after pelvic radiation: transposition until the age of 35 years

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