Table 1.
Characteristics of studies
| First author and year of publication | Study design | Population | Intervention | Outcome(s) | Follow up (median, range) |
|---|---|---|---|---|---|
|
Hodel 1982 [7] |
Retrospective |
Women with vaginal (n = 2) and cervical (n = 7) cancers |
Open-lateral OT in patients undergoing radical surgery followed by pelvic irradiation (n = 9) |
Ovarian function by clinical symptoms and FSH levels |
NR |
|
Husseinzadeh 1984 [20] |
Prospective |
Women with cervical (n = 39) and vaginal (n = 1) cancers |
Open–lateral OT in patients with RH + lymphadenectomy (n = 22), primary radiotherapy alone (n = 14) and radiotherapy following surgery (n = 4) |
Ovarian function by FSH, LH levels, 15/22 from surgery only group were included for which FSH levels were available |
NR |
|
Ploch 1988 [21] |
Prospective |
Women with cervical cancer (n = 22) |
RH with OT of one or both ovaries outside the pelvis (n = 5) followed by adjuvant radiotherapy (n = 17), BR only (n = 5) and BR + teletherapy (n = 12) |
Ovarian function by FSH, LH, E2 and progesterone levels, additional analysis of location of transposed ovaries |
13 (2–23) |
|
Owens 1989 [22] |
Retrospective |
All but 3 patients had early stage cervical cancer (n = 14) |
All but one had bilateral open OT to the paracolic gutters (n = 14) in addition to RH, post-operative radiotherapy (n = 8) |
Oestrogen deficiency symptoms, metastatic disease or required reoperation secondary to new ovarian pathology. |
18 |
|
Chambers 1990 [23] |
Retrospective |
Premenopausal women with cervical cancer stage IA and IB (n = 84) |
Lateral OT in addition to RH (n = 25) compared to non-OT group (n = 59) |
Symptomatic ovarian cysts and symptoms of menopause by FSH and LH levels |
14 (2–23) |
|
Van Beurden 1990 [24] |
Retrospective |
Women with cervical cancer (n = 44) |
Open intraperitoneal OT in a lateral and cranial direction (n = 44): In 16/44 women, only one ovary could be preserved and transposed and radiotherapy (n = 6) |
Menopausal symptoms, measurement of FSH where available (n = 6) |
23 (10–36) |
|
Chambers 1991 [25] |
Retrospective |
Women with stage 1 cervical cancer (n = 38) |
Open (sc) lateral OT (n = 38) as part of their initial operative procedure and post-operative radiotherapy (n = 14) |
Ovarian function by FSH/LH, ovarian preservation directly related to estimated scattered dose to ovaries, symptomatic ovarian cysts by USS |
35 |
|
Anderson 1993 [26] |
Retrospective |
Premenopausal women with early stage cervical cancer (n = 104) |
Open-lateral OT (n = 82) , post-operative radiotherapy (n = 24), comparison with non-OT group (n = 22) |
Retention of ovarian function, symptomatic ovarian cysts and metastases |
44 |
|
Bidzinski 1993 [27] |
Retrospective |
Women with stage Ia and Ib carcinoma of the cervix (n = 48) |
RH with OT (n = 48), EBRT (n = 15) and BR (n = 24) |
Effect on ovarian function |
40 (10–72) |
|
Feeney 1995 [28] |
Retrospective |
Women with stage I-IIa cervical cancer (n = 132) |
Lateral OT at the time of RH (n = 132), post-operative radiotherapy (n = 28) |
Menopausal symptoms, FSH levels and adnexal pathology, Ovarian function is reserved only in 50% of patients with post-operative BR |
24 |
|
Clough 1996 [9] |
Prospective |
Women with cervical cancer (n = 17) |
Laparoscopic unilateral OT (n = 17) post-operative BR (n = 14 ) and EBRT + BR (n = 3) |
Evaluation of ovarian function by clinical and laboratory criteria, 100% ovarian preservation in patients younger than 40 years old |
23 (12–33) |
|
Covens 1996 [29] |
Retrospective |
Patients with 1B cervical cancer prior to radiation therapy (n = 3) |
Laparoscopic OT (n = 3) and had intarcavitary radiation desiring preservation of fertility. |
Menstruating regularly after completion of treatment with serum FSH in the normal premenopausal range. |
32 |
|
Fujiwara 1997 [8] |
Retrospective |
Description of a new technique for OT (n = 27), women with cervical cancer only were included (n = 12) |
Open (sc) OT ovary (benign = 15, cancer = 12) and post-operative EBRT (n = 10) and BR (n = 1) |
Cyst formation, symptoms of menopause with FSH levels measurement |
26 (10–44) |
|
Morice 1998a [30] |
Retrospective |
Women with 27 vaginal cancers, 9 ovarian dysgerminomas and 1 pelvic sarcoma |
Laparoscopic OT |
Ovarian function, cysts and prognosis for fertility |
6 |
|
Morice 1998b [31] |
Prospective |
Only 14/ 24 were included as they were repeated in other paper published by the same author and 4 non gyanecological malignancies, 12 clear cell vaginal and cervical cancers, 1 vaginal adenocarcinoma, 1 dysgerminoma |
Laparoscopic OT (n = 14), BR (n = 13) and EBRT (n = 5) |
Clinical and laboratory follow-up tests of ovarian function and clinical pregnancies. |
6 |
|
Morice 2000 [32] |
Prospective |
Women with cervical cancer (n = 107) |
Laparoscopic bilateral OT to the paracolic gutters with RH and lymphadenectomy only (n = 11), with 60 Gy of vaginal BR along with surgery (n = 59) or surgery, BR and 45 Gy of EBRT (n = 25) |
Ovarian function: by clinical symptoms, FSH, E2 level, 12 patients were lost to follow up, ovarian cysts: by USS |
31 (10–56) |
|
Buekers 2001 [33] |
Retrospective |
Women with cervical cancer (n = 80) |
Open OT to one or both ovaries at the time of exploration for RH or staging lymphadenectomy, postoperative irradiation (n = 26) |
Ovarian function by FSH, report of cyclic signs and menopausal symptoms, analysis of estrogen effect to vaginal epithelium |
85 (43–126) |
|
Olejek 2001 [34] |
Retrospective |
Women with cervical cancer for which follow up was available (n = 44) |
Open OT, comparison of ovarian preservation between RT and non-RT groups |
Ovarian function by FSH, LH, E2, PRL, testosterone, ovarian cysts by USS |
60 |
|
Yamamoto 2001 [10] |
Prospective |
Women with cervical cancer (n = 56) Regression analysis of risk factors for ovarian metastases |
Open OT during RH only (n = 30), with pelvic irradiation (n = 26) |
Ovarian function by basal bosy temperature, FSH, E2 and PG, regression analysis of risk factors for ovarian metastases |
12 |
|
Nagao 2006 [35] |
Retrospective |
Comparison between OT (n = 27)and 2 non-OT groups (n = 59) for ovarian preservation |
Open OT following RH (n = 27) |
Ovarian function by FSH |
65 |
|
Pahisa 2008 [36] |
Prospective |
Women with 1b1 cervical cancer (n = 28) |
Laparoscopic OT with no RT(n = 16), BR (n = 7) and EBRT + BR (n = 5) |
Ovarian function by clinical symptoms and FSH and E3; follow up available for 24/28 patients, ovarian cysts by annual surveillance abdominal CT |
44 |
|
Al-Badawi 2010 [37] |
Retrospective |
Women with cervical cancer (n = 15) |
Bilateral laparoscopic OT to the paracolic gutters with uterine preservation followed by pelvic irradiation (n = 15) |
Ovarian function by clinical symptoms and FSH |
33 |
|
Han 2011 [38] |
Retrospective |
Women with cervical cancer (n = 29), comparison with non-OT group |
OT in cervical cancer patients (n = 29) prior to pelvic irradiation |
Ovarian function by E2 and FSH, 19/29 patients were included for which hormonal levels were available |
17.2 |
| Hwang 2012 [39] | Retrospective | Women with cervical cancer (n = 53), 39/53 patients were included | Open (n = 19) and laparoscopic (n = 34) OT to the paracolic gutters with primary chemoradiotherapy only (n = 3), with RH and lymphadenectomy (n = 33) followed by adjuvant RT (n = 23), with lymphadenectomy followed by primary chemoradiotherapy (n = 17) | Ovarian function by clinical symptoms and FSH,14/53 patients were lost on follow up or FSH not available | 39.8 |
sc = Subcutaneous.
NR = Not reported.
OT = Ovarian transposition.