Ovarian transposition in cervical cancer

One hundred four premenopausal women, 42 years of age or less, with early stage carcinoma of the cervix had surgical management with ovarian retention. Eighty-two had ovarian transposition performed at the time of exploration for radical hysterectomy or staging lymphadenectomy because of known or possible need for radiation therapy. Twenty-two had radical hysterectomy and retained ovaries without transposition. Three patients, all in the transposed group, were lost to follow-up. Sixteen patients died of disease; all but 1 were in the transposed group. Twenty-four transposed patients received postoperative radiation therapy; 12 of these died of disease and all became climacteric prior to death. Only 4 (17%) transposed and radiated patients have continued ovarian function. Of the 58 patients with transposition who received no radiation, 9 of 51 survivors (17.6%) had subsequent oophorectomy for management of painful ovarian cysts at from 25 to 103 months (mean 46.8 months) after treatment. Sixty-seven percent still have ovarian pain and cysts requiring medical therapy. Therefore, only 53% retained ovarian function with no problems. Of the 22 patients whose ovaries were retained but not transposed 10% became climacteric at a mean of 84 months after treatment, and 21% have continued ovary-related pain or cysts at a mean of 32 months. Thus, 71% retained ovarian function and had no problems. The difference in ovarian survival between the transposed and radiated and the nontransposed nonradiated groups was significant (P < 0.001). Only 1 patient developed metastatic disease in the ovary at 17 months and 1 had a benign cystic teratoma at 62 months after treatment. We conclude that transposition is not successful in preserving ovarian function in patients who are likely to need radiation therapy and is, therefore, not indicated. Long-term follow-up is necessary to determine rates of continued ovarian function after surgery. The rate of subsequent malignancy is low.