DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20172297

Ovarian preservation with lateral ovarian transposition in operable Ca cervix: experience at a tertiary care center

Tony Jose, Amarinder Singh, Pooja Sinha, Sumit Bidari

Abstract


Background: The benefits of ovarian preservation during radical surgery for ca cervix in premenopausal patients far outweigh the risk of ovarian disease later. However, adjuvant pelvic radiotherapy damages retained ovaries. Mobilization and transposition of these ovaries during surgery outside the pelvis prevents or reduces radiation damage to these ovaries. A prospective observational study was conducted to objectively study the effect of ovarian preservation with Lateral Ovarian Transposition (LOT) on ovarian function on operated patients of Ca cervix.

Methods: All pre-menopausal patients of Ca cervix <45 years, planned for surgery underwent FSH levels to assess ovarian function and were screened for ovarian disease. Eligible patients who consented underwent ovarian retention (OR) with LOT during surgery. Adjuvant treatments as indicated was administered and all patients were followed up at 3, 6 and 12 months after surgery for subjective (symptoms) and objective (FSH) evidence of ovarian failure.

Results: LOT could be successfully performed in all patients. Though the mean FSH values did show a rise after surgery, this was more pronounced in patients receiving radiotherapy (RT). Ovarian function continued normally in 63% of all patients with 72% retaining ovarian function when RT was not administered. Hot flashes (HF) and Vaginal dryness(VD) were the most common symptoms but its onset was gradual and symptoms milder compared to surgical menopause.

Conclusions: LOT is an oncologicaly safe, technically feasible and reasonably effective procedure for preserving ovarian function during surgical treatment and even after adjuvant RT in Ca Cervix and should be offered to eligible premenopausal patients.


Keywords


Carcinoma cervix, Follicle stimulating hormone, Hot flashes, Lateral Ovarian transposition, Ovarian retention

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References


McCall ML, Keaty EC, Thompson JD. Conservation of ovarian tissue in the treatment of carcinoma of the cervix with radical surgery. Am J Obstet Gynecol. 1958 ;75:590-605.

Webb GA. The role of ovarian conservation in the treatment of carcinoma of the cervix with radical surgery. Am J Obstet Gynecol. 1975;122:476-84.

Landoni F, Zanagnolo V, Lovato-Diaz L, Maneo A, Rossi R, Gadducci A et al. Ovarian metastases in early-stage cervical cancer (IA2-IIA): a multicenter retrospective study of 1965 patients (a Cooperative Task Force study). Int J Gynecol Cancer. 2007;17:623-8.

Gubbala K, Laios A, Gallos I, Pathiraja P, Haldar K, Ind T. Outcomes of ovarian transposition in gynaecological cancers; a systematic review and meta-analysis. J Ovar Res. 2014;7:69.

Lushbaugh CC, Casarett GW. The effects of gonadal irradiation in clinical radiation therapy: a review. Cancer. 1976;37:1111-20.

Hodel K, Rich WM, Austin P, DiSaia PJ. The role of ovarian transposition in conservation of ovarian function in radical hysterectomy followed by pelvic radiation. Gynecol Oncol. 1982;13:195-202.

Anderson B, La Polla J, Turner D, Chapman G, Buller R. Ovarian transposition in cervical cancer. Gynecol Oncol. 1993;49:206-14.

Belinson JL, Doherty M, McDay JB. A new technique for ovarian transposition. Surg Gynecol Obstet. 1984;159:157-60.

Piver MS, Rutledge F, Smith JP. Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol. 1974;44:265-72.

Yamamoto R, Okamoto K, Yukiharu T, Kaneuchi M, Negishi H, Sakuragi N et al. A study of risk factors for ovarian metastases in stage IB–IIIB cervical carcinoma and analysis of ovarian function after a transposition. Gynecol Oncol. 2001;82:312-6.

Zhao C, Wang JL, Wang SJ, Zhao LJ, Wei LH. Analysis of the risk factors for the recurrence of cervical cancer following ovarian transposition. Eur J Gynaecol Oncol. 2013;34:124-7.

Lo Presti A, Ruvolo G, Gancitano RA, Cittadini E. Ovarian function following radiation and chemotherapy for cancer. Eur J Obstet Gynecol Reprod Biol. 2004;113:S33-40.

Hwang JH, Yoo HJ, Park SH, Lim MC, Seo SS, Kang S et al. Association between the location of transposed ovary and ovarian function in patients with uterine cervical cancer treated with (postoperative or primary) pelvic radiotherapy. Fertil Steril. 2012;97:1387-93.

Ellsworth LR, Allen HH, Nisker JA. Ovarian function after radical hysterectomy for stage IB carcinoma of the cervix. Am J Obstet Gynecol. 1983;145:185-8.

Plockinger B, Kolbl H. Development of ovarian pathology after hysterectomy without oophorectomy. J Am Coll Surg. 1994;178:581-85.

Menon RK, Okonofua FE, Agnew JE, Thomas M, Bell J, O’Brien PMS, Dandona P. Endocrine and metabolic effects of simple hysterectomy. Int J Obstet Gynecol. 1987;25:459-63.

Belinson JL, Doherty M, McDay JB. A new technique for ovarian transposition. Surg Gynecol Obstet. 1984;159:157-60.

Feeney DD, Moore DH, Look KY, Stehman FB, Sutton GP. The fate of the ovaries after radical hysterectomy and ovarian transposition. Gynecol Oncol. 1995;56:3-7.

Chambers SK, Chambers JT, Holm C, Peschel RE, Schwartz PE. Sequelae of lateral ovarian transposition in unirradiated cervical cancer patients. Gynecol Oncol. 1990;39:155-9

Buekers TE, Anderson B, Sorosky JI, Buller RE. Ovarian Function after Surgical Treatment for Cervical Cancer. Gynecologic Oncol. 2001;80:85-8.

Yoon A, Lee YY, Park W, Huh SJ, Choi CH, Kim TJ, et al. Correlation between location of transposed ovary and function in cervical cancer patients who underwent radical hysterectomy. Int J Gynecol Cancer. 2015;25(4):688-93.