Preservation of ovarian function after high ovarian transposition to the upper abdomen prior to pelvic radiation therapy in patients with pelvic malignancy: a case series.

OBJECTIVE: Traditional ovarian transposition to the level of the pelvic brim before pelvic radiation has allowed preserved ovarian function in less than 67% of women. This case series aimed to describe ovarian function and peri-operative complications after novel high ovarian transposition to the upper abdomen and pelvic radiation for malignancy.

METHODS: We conducted a retrospective chart review of pre-menopausal women with pelvic malignancy who underwent high ovarian transposition followed by radiation at a tertiary care center between 2013 and 2023. The ovaries were mobilized, along with the gonadal vessels, toward their origin and secured at the level of the inferior liver edge on the right and the splenic flexure on the left. The primary outcome was premature ovarian insufficiency/early menopause and the secondary outcomes were peri-operative complications.

RESULTS: A total of 49 women underwent high ovarian transposition at a median age of 32 years (range; 19-45). A total of 47 women went on to receive pelvic radiation, including 23 brachytherapy (49%) and 41 external beam radiation (87%). After a median follow-up of 28 months, 5 of 49 women (11%) experienced premature ovarian insufficiency/early menopause. Of those who underwent no concurrent oncologic procedures, 3 of 32 (9%) experienced ovarian insufficiency. There were no intra-operative complications. One patient had recurrence in a transposed ovary, one had ovarian torsion, one had chronic abdominal pain, and one had symptomatic benign ovarian cysts.

CONCLUSIONS: In this case series, high ovarian transposition was shown to be a safe and potentially effective option for pre-menopausal patients with pelvic malignancy requiring pelvic radiation preserving ovarian function in approximately 90% of patients.