Benefits and side effects of lateral ovarian transposition (LOT) performed during radical hysterectomy and pelvic lymphadenectomy for early stage cervical cancer

Abstract

Ovarian function and ovarian cyst formation after radical hysterectomy and pelvic lymphadenectomy with lateral ovarian transposition (LOT) have been retrospectively examined in 54 patients with early stage cervical cancer (FIGO IB or IIA) with a follow-up of 3-7 years. Patients were divided into two groups: those without adjuvant pelvic radiotherapy (36 patients) and those with adjuvant pelvic radiotherapy (18 patients). Ninety-one percent (33/36) of the patients without adjuvant pelvic radiotherapy and 66% (12/18) of the patients with adjuvant pelvic radiotherapy remained without evidence of recurrent disease. Of the 36 patients who did not receive adjuvant pelvic radiotherapy, only two patients became postmenopausal (5.5%). However, of the 18 patients who also received adjuvant pelvic radiotherapy, 5 became postmenopausal (28%). There was a tendency to become postmenopausal if the scatter radiation dose at the transposed ovaries was 300 cGy or more, but our series is too small to allow a definite conclusion. This scatter radiation dose did not depend on the distance the ovaries were placed from the linea innominata, because of the variation in the level of the cranial border of the radiation field. Three out of 54 patients (5.5%) developed symptomatic ovarian cysts, of which 2 required surgical intervention because of pain symptoms. Remarkably, in one of them cyst formation occurred 5 years after surgery. Of the 3 patients with symptomatic ovarian cysts this was the only patient who received adjuvant pelvic radiotherapy. From these data it can be concluded that LOT protects ovarian function in most patients undergoing radical hysterectomy and pelvic lymphadenectomy for early stage cervical cancer, even if they receive adjuvant pelvic radiotherapy, with an acceptable risk of development of symptomatic ovarian cysts.