Benefits and side effects of lateral ovarian transposition (LOT) performedduring radical hysterectomy and pelvic lymphadenectomy for early stage cervical cancer
Ma. Van Eijkeren et al., Benefits and side effects of lateral ovarian transposition (LOT) performedduring radical hysterectomy and pelvic lymphadenectomy for early stage cervical cancer, INT J GYN C, 9(5), 1999, pp. 396-400
Ovarian function and ovarian cyst formation after radical hysterectomy and
pelvic lymphadenectomy with lateral ovarian transposition (LOT) have been r
etrospectively examined in 54 patients with early stage cervical cancer (FI
GO 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 t
he patients with adjuvant pelvic radiotherapy remained without evidence of
recurrent disease.
Of the 36 patients who did not receive adjuvant pelvic radiotherapy, only t
wo patients became postmenopausal (5.5%). However, of the 18 patients who a
lso received adjuvant pelvic radiotherapy, 5 became postmenopausal (28%). T
here 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 whi
ch 2 required surgical intervention because of pain symptoms. Remarkably, i
n one of them cyst formation occurred 5 years after surgery. Of the 3 patie
nts with symptomatic ovarian cysts this was the only patient who received a
djuvant pelvic radiotherapy.
From these data it can be concluded that LOT protects ovarian function in m
ost patients undergoing radical hysterectomy and pelvic lymphadenectomy for
early stage cervical cancer, even if they receive adjuvant pelvic radiothe
rapy, with an acceptable risk of development of symptomatic ovarian cysts.