Uterine transposition for gynecological cancers

Abstract

ObjectiveUterine 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.MethodsWe 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.ResultsFour 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.ConclusionsUterine 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.

Brazilian Society of Surgical Oncology consensus on fertility‐sparing surgery for cervical cancer

“…Uterine transposition was first described by Ribeiro et al for a woman with rectal cancer that received pelvic radiation and still desired to preserve fertility 80,81 . A case series was recently published and included five gynecologic cancer cases— four cervical and one vaginal cancer 82 . It seems to be a feasible and reproductible surgical technique to preserve fertility in selected cases; however, the oncologic safety and obstetric outcomes are still pending.…”

“…">Should uterine transposition be considered an option for women submitted to radical trachelectomy that have an indication of adjuvant pelvic radiotherapy?Uterine transposition was first described by Ribeiro et al for a woman with rectal cancer that received pelvic radiation and still desired to preserve fertility 80,81 . A case series was recently published and included five gynecologic cancer cases— four cervical and one vaginal cancer 82 . It seems to be a feasible and reproductible surgical technique to preserve fertility in selected cases; however, the oncologic safety and obstetric outcomes are still pending.Recommendation: Uterine transposition is a viable alternative for fertility preservation after radical trachelectomy before adjuvant pelvic radiotherapy.Level of evidence: VGrade of recommendation: CVoting result: 76.5% (39) agree, 9.8% (5) disagree, 13.7% (7) abstention (51 voters) …”

“…80,81 A case series was recently published and included five gynecologic cancer cases-four cervical and one vaginal cancer. 82 It seems to be a feasible and reproductible surgical technique to preserve fertility in selected cases; however, the oncologic safety and obstetric outcomes are still pending.…”

Uterine transposition after radical trachelectomy

“…In addition, menses and hormonal function are maintained, but this information is based on very limited data, published by our group. 23 Complications may occur and based on our experience (not published data) uterine necrosis and cervical stenosis are the major concerns. Due to limited experience, it is not possible to accurately predict all complications and patients must be aware of this when consenting to having a uterine transposition.…”

“…Recently, we have published 23 the first series of cases of uterine transposition in women with gynecologic cancer. Four patients completed the uterine transposition and one patient decided on uterus removal before reimplantation.…”