Laparoscopic ovarian transposition for pelvic malignancies: Indications and functional outcomes

Objective: To assess the indications and effectiveness of laparoscopic ovarian transposition before pelvic irradiation for a gynecologic cancer. Design: Prospective study. Setting: A gynecologic oncology department in a French anti-cancer center. Patient(s): Twenty-four patients treated for pelvic cancer. Intervention(s): Laparoscopic ovarian transposition to paracolic gutters. Uterine conservation in 18 patients. Main Outcome Measure(s): Clinical and laboratory follow-up tests of ovarian function. Result(s): Bilateral laparoscopic ovarian transposition was achieved in 22 patients (94%). Twelve patients were treated for clear cell adenocarcinoma of the cervix and/or upper vagina, 6 patients for invasive squamous cervical carcinoma, 3 patients for pelvic sarcoma, 1 patient for recurrent cervical cancer to the upper vagina, 1 patient for ependymoma of the cauda equina, and 1 patient for ovarian dysgerminoma. Ovarian preservation was achieved in 79%. Three pregnancies were obtained. Conclusion(s): Laparoscopic ovarian transposition is a safe and effective procedure for preserving ovarian function. Bilateral ovarian transposition should be performed. The main indications for laparoscopic ovarian transposition are a patient with a small invasive cervical carcinoma (<2 cm) in a patient <40 years of age who is treated by initial laparoscopically assisted vaginal radical hysterectomy and a patient with a clear cell adenocarcinoma of the cervix and upper vagina.