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Uterine transposition for gynecological cancers
  1. Glauco Baiocchi1,
  2. Marcelo Vieira2,
  3. Renato Moretti-Marques3,
  4. Henrique Mantoan1,
  5. Carlos Faloppa1,
  6. Rachel Cruz Fraga Damasceno4,
  7. Sálua Oliveira Calil Paula5,6,
  8. Audrey Tieko Tsunoda7 and
  9. Reitan Ribeiro7
  1. 1 Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
  2. 2 Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
  3. 3 Department of Gynecologic Oncology, Albert Einstein Israelite Hospital, Sao Paulo, Brazil
  4. 4 Department of Gynecology, Baleia Hospital, Belo Horizonte, Minas Gerais, Brazil
  5. 5 Department of Gynecology, Mario Penna Institute, Belo Horizonte, Brazil
  6. 6 Department of Gynecology, Mater Dei Rede de Saúde, Belo Horizonte, Brazil
  7. 7 Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba, Brazil
  1. Correspondence to Dr Reitan Ribeiro, Hospital Erasto Gaertner, Curitiba 81520-058, Brazil; reitanribeiro{at}hotmail.com

Abstract

Objective Uterine transposition has emerged as an alternative for fertility preservation in women with pelvic malignancies that require radiotherapy. The goal of this study was to evaluate the short-term outcomes of patients undergoing uterine transposition after trachelectomy for cervical cancer or before chemoradiation for vaginal cancer.

Methods We retrospectively evaluated patients with early stage cervical cancer after radical trachelectomy or with vaginal cancer with indication for pelvic radiation who had uterine transposition performed as fertility sparing strategy.

Results Four patients with cervical cancer and one patient with vaginal cancer were included. Median age was 32 years (range 28–38). All patients had squamous cell carcinomas. All patients with cervical cancer had radical trachelectomies with sentinel lymph node dissection (SLN). Two of these patients also had pelvic lymphadenectomies. Indications for adjuvant radiotherapy was due to Sedlis criteria in two patients and to lymph node metastasis in the other two patients. The patient with stage IIB vaginal cancer was recommended primary chemoradiation. All patients underwent uterine transposition before radiotherapy. The median uterine transposition surgical time was 90 min (range 80-205) and no early complications (30 days) occurred. Average time from uterine transposition to start of radiotherapy was 16 days (10–28). After radiation, the uterus along with the ovaries and tubes were repositioned and the residual cervix sutured to the vagina. One patient declined uterine reimplantation after radiation and underwent a hysterectomy. After a median follow-up of 25 months (range 1–30), all patients were without evidence of disease. All patients with preserved uterus have normal menses after treatment. One patient has attempted to conceive with IVF techniques without success.

Conclusions Uterine transposition may be an option in selected patients with cervical and vaginal cancers who want to preserve fertility. However, further studies that address its oncological safety and obstetrical outcomes are encouraged.

  • cervical cancer
  • vaginal cancer
  • uterine transposition
  • radical trachelectomy
  • fertility sparing
  • radiotherapy

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Footnotes

  • Twitter @glaucobaiocchi

  • Contributors All authors contributed significantly to the preparation and revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Data availability statement No data are available.

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