Article Text

Download PDFPDF

2022-RA-1545-ESGO Uterine transposition: is it an option for fertility sparing in locally advanced cervical cancer
  1. Maria Ercilia Ibarra,
  2. Sebastián Altuna,
  3. Martín Mariano Ballarin,
  4. Maria Magdalena Betti,
  5. Carolina Maya,
  6. Tomás Demarco and
  7. Juan Carlos Balparda
  1. Ginecologia, Hospital universitario Austral, Provincia de Buenos Aires, Argentina


Introduction/Background In Argentina, cervical cancer is the second most frequent and 1,600 women die from this cause per year. Conventional fertility preservation surgical treatments are not viable treatment options in advanced stages. Uterine transposition was promoted by Dr. Reitán Ribeiro.

Methodology We present two cases reports of patients with cervical cancer FIGO 2018 stage IIIC1 despite this, they insisted on preserving fertility. Both nulliparous, 29 and 34 years old, the first case referred with Loop Electrosurgical Excision Procedure (LEEP): 0.7x0.5 cm with squamous no queratinizante carcinoma + HSIL in endocervix. The second case had LEEP: 1.3x1.2x0.3 cm with endocervical adenocarcinoma and compromised margins. Both had Magnetic Resonance (MR) without residual tumor; only finding: 44 mm and 8 mm obturator lymph node respectively. PET-CT: Distant hypermetabolic foci not seen. Oocyte cryopreservation in both. Subsequently, the first surgery: laparoscopic sentinel lymph nodes with intraoperative frozen-section confirming macrometastasis. The uterus and ovaries were transposed without the cervix to the upper abdomen. Ultrasound was used to guide the section on the uterus, leaving a uterine remnant of at least 1 cm suitable for cerclage. With the cervix in the pelvic position, primary treatment: concurrent chemoradiotherapy with cisplatin (6 cycles) and brachytherapy was started on postoperative day 20. Subsequently, in the second surgery, a simple trachelectomy was performed and repositioning of the uterus in the pelvis with negative margin frozen section

Results After 18 and 10 months of follow-up with physical examination, images and cytology-HPV cotesting, no signs of recurrence.

Conclusion We emphasize the importance of strict informed consent, explaining risks and benefits, especially in this controversial case that goes against scientific evidence. They were carefully selected cases with tumours less than 2 cm, without residual disease by MR post LEEP, and the best treatment tested by stage was respected without delay. Pending longer follow-up in time.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.