Robotically Assisted Laparoscopic Ovarian Transposition in Women with Lower Gastrointestinal Cancer Undergoing Pelvic Radiotherapy.
BACKGROUND
Pelvic radiotherapy (RT) is a standard component of the management for patients with locally advanced rectal cancer or squamous cell carcinoma of the anus. Pelvic RT leads to permanent and irreversible ovarian failure in young women. This study aimed to determine the effectiveness of robotically assisted laparoscopic ovarian transposition (OT) before RT in women with rectal or anal cancer who wanted to preserve normal ovarian function.


METHODS
The study reviewed the medical records of all patients treated at our institution from August 2009 to October 2014 who received robotically assisted laparoscopic OT for rectal or anal cancer before RT. Clinical and hormonal data were abstracted to determine ovarian function.


RESULTS
The study identified 22 women with rectal (n = 20) or anal (n = 2) cancer. The median age of the women was 39 years (range 26-45 years). For one patient, OT was technically not feasible. The postoperative course was uneventful in all but one case. Follow-up data on ovarian function were unavailable for 3 patients. The median times from RT initiation to the last gynecologic or hormonal evaluation were 9 months (range 5-47 months) and 10.5 months (range 5-47 months), respectively. At the last gynecologic or hormonal follow-up visit, ovarian function was preserved in 12 (67%) of 18 evaluable patients, including 9 (90%) of 10 patients 40 years of age or younger and 3 (38%) of 8 patients older than 40 years (P = 0.07).


CONCLUSIONS
Robotically assisted laparoscopic bilateral OT is safe and can lead to preservation of ovarian function in two-thirds of patients with low gastrointestinal cancer undergoing pelvic RT. It should be considered in this setting, especially for women age 40 years or younger, to avoid premature menopause and its associated sequelae.
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Vasileios D
VD
Sioulas
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Soledad
S
Jorge
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Jing-Yi
JY
Chern
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Maria B
MB
Schiavone
Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Martin R
MR
Weiser
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Joanne F
JF
Kelvin
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
Ginger J
GJ
Gardner
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
Yukio
Y
Sonoda
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
Nadeem R
NR
Abu-Rustum
Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, Denver, CO, USA.
Karyn A
KA
Goodman
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. leitaom@mskcc.org.|Weill Cornell Medical College, New York, NY, USA. leitaom@mskcc.org.
Mario M
MM
Leitao
D000328:Adult; D001005:Anus Neoplasms / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D010053:Ovary / Q000601:surgery*; D012004:Rectal Neoplasms / Q000532:radiotherapy*; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome