Objective To evaluate the feasibility of uterine transposition as a method of preserving fertility and ovarian function after pelvic radiation.
Methods This prospective multicenter observational study included patients with non-gynecologic pelvic cancers who underwent pelvic radiation as part of their cancer treatment between June 2017 and June 2019. For inclusion in the study, patients were required to have normal menstrual cycles and hormone levels (follicle-stimulating hormone, luteinizing hormone, and estrogen) before treatment. Uterine transposition to the upper abdomen was performed prior to irradiation. Clinical examinations and Doppler ultrasonography were used to evaluate the gonadal vasculature post-surgery. The uterus was repositioned into the pelvis 2–4 weeks after radiation therapy or at the time of rectosigmoid resection in patients with rectal cancer who had undergone neoadjuvant treatment. Cancer treatment and follow-up were performed according to standard guidelines.
Results Eight patients (seven with rectal cancer and one with pelvic liposarcoma) underwent uterine transposition at a median age of 30.5 years (range 19–37). The uterus was successfully preserved in six patients, accompanied by normal menses, hormonal levels, and vaginal intercourse after treatment. One patient with rectal cancer died of carcinomatosis 4 months after uterine transposition. One patient presented with uterine necrosis 4 days after uterine transposition, and the uterus was removed; however, one ovary was preserved. Cervical ischemia was the most common post-surgical complication in three (37.5%) patients. Three patients attempted to conceive, and two (66%) were spontaneously successful and delivered healthy babies at 36 and 38 weeks by cesarean section without complications.
Conclusions Uterine transposition is a feasible procedure for preserving gonadal and uterine function in patients requiring pelvic radiotherapy for non-gynecological cancer, with the potential for achieving spontaneous pregnancy and successful delivery.
- Colorectal Neoplasms
- Gynecologic Surgical Procedures
- Postoperative complications
- Adnexal Diseases
Data availability statement
Data are available upon reasonable request.
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Contributors RR and JCL contributed to study planning, conceptualization, surgical data collection, data analysis, writing the original draft of manuscript, and reviewing and editing the manuscript. GB, RM-M, and RP contributed to surgical data collection, data analysis, writing the original draft of manuscript, and reviewing the manuscript. CNC contributed to study conceptualization, oncology data collection, data analysis, writing the original draft of manuscript, and reviewing the manuscript. All authors had access to the data reported in the study and had final responsibility for the decision to submit the manuscript for publication. RR is responsible for the overall content as the guarantor.
Funding The study was founded by the Erasto Gaertner Hospital.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.