Friday, August 4, 2017

Uterine transposition: A novel option to preserve fertility in patients requiring pelvic chemoradiation

Courtesy: University of Queensland.

Uterine transposition is an interesting and novel technique not ever reported in literature. This is the first case report of uterine transposition and technique published in August issue of Journal Fertility and Sterility.

All gynecologists are familiar with transposing ovaries to preserve fertility and avoid premature menopause in patients who require radiation treatment to the pelvis for cervical cancer.

Dr Reitan Ribeiro from Brazil reports the case of a 26-year-old woman diagnosed with rectal adenocarcinoma located 5 cm from the anal margin. The patient was young and did not have any children and wanted to preserve her fertility.

Dr Ribeiro offered the patient a repositioning of the uterus outside the pelvic cavity called along with the ovaries outside the pelvic cavity, to save them from harm due to pelvic radiation.

The maximum tolerated radiation dose for the ovaries is 15 Gy; for uterus and cervix it is 20 Gy to 30 Gy. But, the radiation dose for curing rectal cancer is significantly higher and is approximately 50 Gy, at which all the pelvic organs will be certainly damaged.

After the radiation treatment was complete the uterus was repositioned back into the pelvic cavity.
The entire procedure was carried out laparoscopically (key hole surgery) without a big abdominal incision. The basis for this procedure is that the blood vessels to the ovaries provide also good blood supply for the uterus at the same time.

The uterus and ovarian functions were preserved as evident by 2 menstrual period that began after 2 weeks of repositioning the uterus back and the cyclic ovarian hormonal variation was maintained at the time of neoadjuvant therapy.

At per speculum examination at 6 weeks the cervix was entirely normal looking and at 18 months follow up the uterus appeared to be normal.

The paper was also presented by Dr. Ribeiro at Society of Gynecologic Oncology 2017Annual Meeting from 10 to 14 March in Washington D.C.

He did acknowledge that further studies are warranted to establish the safety and efficacy of the procedure. The spread of tumor to a location not easily amenable to treatment was a major concern.
Dr Riberio and colleagues have launched a Uterine Transposition: Feasibility Study  and will shortly start recruiting patients.

This prospective nonrandomized multicenter phase I study, will evaluate the feasibility of performing uterine transposition before chemoradiation for rectal cancer and uterine reimplantation after the treatment. 

The authors concluded that, “Uterine transposition might represent a valid option for fertility preservation in women who require pelvic radiotherapy and want to bear children.” 

Related link: Ovarian Transposition: A novel laparoscopic surgical method video by Cleveland Clinics.

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