The Fate of the Ovaries after Radical Hysterectomy and Ovarian Transposition

• Published in: Gynecologic oncology Vol. 56; no. 1; pp. 3 - 7
• Main Authors: Feeney, Daniel D., Moore, David H., Look, Katherine Y., Stehman, Frederick B., Sutton, Gregory P.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: San Diego, CA Elsevier Inc 01.01.1995; Elsevier
• Subjects: Adult; Biological and medical sciences; Combined Modality Therapy; Female; Follicle Stimulating Hormone - blood; Follow-Up Studies; Humans; Hysterectomy - methods; Lymph Node Excision; Medical sciences; Menopause - physiology; Middle Aged; Ovarian Cysts - etiology; Ovarian Diseases - etiology; Ovary - physiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Torsion Abnormality; Uterine Cervical Neoplasms - radiotherapy; Uterine Cervical Neoplasms - surgery; Human; Carcinoma; Ovarian function; Bibliographic survey; Malignant tumor; Uterine cervix; Hysterectomy; Radiotherapy; Radical; Female genital diseases; Ovary; Transposition; Conservative surgery; Treatment; Surgery; Risk factor; Uterine cervix diseases
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1006/gyno.1995.1002

To assess the effectiveness of lateral ovarian transposition in preserving normal ovarian function, the medical records of 200 consecutive women with stage I-IIA cervical cancer treated primarily with radical hysterectomy and pelvic lymphadenectomy were reviewed. Lateral ovarian transposition was performed at the time of radical hysterectomy in 132 (66%) patients and 28 (21%) received postoperative pelvic radiation therapy. Menopausal symptoms (vaginal dryness, hot flushes) and follicle-stimulating hormone (FSH) levels were used to define ovarian function. Only 3/104 (2.9%) patients who underwent lateral ovarian transposition without postoperative pelvic radiotherapy experienced menopausal symptoms; however, FSH levels in all three cases suggested continued ovarian function. In 14/28 (50%) patients who received postoperative pelvic radiation therapy ovarian failure occurred. The risk of ovarian failure with pelvic radiation therapy after lateral ovarian transposition was significant (RR = 17.3; 95% CI = 5.35-56.13). The incidence of adnexal disease in transposed ovaries requiring analgesics or further surgery was 3%. These data suggest minimal risk to the patient when the ovaries are conserved. Unfortunately, lateral ovarian transposition preserves ovarian function in only 50% of patients undergoing pelvic radiotherapy following radical hysterectomy.