Uterine transposition before radiation therapy in young female rectal cancer patients: A novel technique aimed at preserving fertiliy.

Abstract

e19592 Background: Neoadjuvant radiation therapy is standard in the management of locally advanced ano-rectal cancer. Laparoscopic ovarian tranposition is routinely proposed to preserve endocrine function in young patients. However, direct external irradiation of the uterus usually alters endometrial and myometrial funcion, impairing the development and outcome of pregnancy. The only recourse is then surrogacy, that raises unsolved ethical issues and is not legal in many countries. Methods: We report the first attempts at surgical uterine transposition before irradition for rectal cancer in three patients between October and December 2009. The rationale of this operation is to elevate the uterine corpus outside the pelvis thus moving the endometrium away from the irradiation field. Ventrofixation of the uterus has long been described using an open approach in the management of uterine prolapse. As this operation can be performed laparoscopically at the time of ovarian tranposition, it does not delay the initation of definitive therapy. Results: Although modern high precision radiation techniques may reduce the amount of radiation delivered to the uterus, it is clear that moving the endometrium away from the main irradiation field provides a much better protection. Preliminary data show that radiation dose does not exceed 12 grays after uterine transposition. No surgical complication was observed. Menses spontaneously resumed in the first two patients with over one month follow-up. Follow-up is too short to provide obstetrical data but it is clear that uterine transpositon is a novel technique that can be proposed to young patients presenting with rectal cancer. Conclusions: Whenever applicable, the concept can be extended to other pelvic malignancies in children and young female patients. For cured patients, avoiding the burden of definitive infertility or high-risk pregnancy is a substantial improvement in quality of life. No significant financial relationships to disclose.