Laparoscopic uterine fixation to spare fertility before pelvic radiation therapy

Laparoscopic uterine fixation is a feasible technique. It should be discussed for reproductive-age patients before undergoing pelvic radio therapy for anal or rectal cancer to decrease uterine radiation therapy side-effects.

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Volume 110, Issue 5, Pages 974–975

Authors:

Henri Azaïs, M.D., Ph.D., Charles-Henri Canova, M.D., Elie Vesale, M.D., Jean-Marc Simon, M.D., Geoffroy Canlorbe, M.D., Ph.D., Catherine Uzan, M.D., Ph.D.

Abstract:

Objective

To describe a surgical technique for laparoscopic uterine fixation (LUF) to decrease uterine radiation therapy side effects in case of rectal or anal cancer.

Design

This video article uses a surgical case to demonstrate the detailed technique. Institutional Review Board approval was not required for this video presentation.

Setting

University hospital.

Patient(s)

A 26-year-old nulliparous female patient diagnosed with rectal adenocarcinoma and liver metastases. After the completion of right hepatectomy and neoadjuvant chemotherapy with the use of the FOLFOX regimen, pelvic radiation therapy was applied before tumor excision.

Intervention(s)

The patient underwent laparoscopic ovarian transposition. During the same intervention, we fixed the uterus with three late resorbable sutures into the fascia of the anterior abdominal wall as cranial as possible to remove the uterus away from the radiation field.

Main outcome measure(s)

Value and feasibility of LUF.

Result(s)

LUF was feasible and effective. Estimated isodoses demonstrated that this intervention may decrease uterine consequences of pelvic radiotherapy. The patient did not report any specific pain or complication in the postoperative period. Three months after the completion of pelvic concurrent chemoradiation therapy, the patient had normal menstrual periods. Hormonal blood tests were satisfactory. Ultrasound showed persistent ovarian function.

Conclusion(s)

Considering its simplicity of realization, LUF should be discussed for reproductive-age patients before undergoing pelvic radiotherapy for anal or rectal cancer. A close collaboration is required between surgeons and radiation oncologists to optimize the treatment and to decrease side-effects of radiotherapy. Intensity-modulated radiation therapy may contribute to enhance a multimodal fertility-sparing strategy in global management of young patients.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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