Utero-ovarian Transposition in Patients With Pelvic Malignancies Undergoing Whole Pelvic Radiotherapy

Prior treatment

• Prior Pelvic Radiotherapy.
• Prior history of systemic chemotherapy and immunotherapy that resulted in significant toxicity and residual deficit.

Other illness

• Advanced Cancer Stage: Patients with locally advanced or metastatic disease.
• Other unlisted conditions or diagnoses that, in the opinion of the primary investigator, render the patient an unsuitable candidate for uteroovarian transposition.

Lab values

• Poor General Health or Comorbidities: Severe medical conditions that contraindicate surgical intervention, that include but not limited to:
  • Cardiovascular Disease:
  • Recent (within 6 months) myocardial infarction (MI).
  • Ejection fraction (EF): EF \<30%.
  • Uncontrolled hypertension: Systolic BP \>180 mmHg or Diastolic BP \>110 mmHg prior to surgery.
  • Severe aortic stenosis: Valve area \<1 cm² with symptomatic status.
  • Uncontrolled Diabetes Mellitus:
  • Hemoglobin A1c (HbA1c) \> 9%
  • Persistent fasting glucose \>250 mg/dL preoperatively despite optimization.
  • Severe Respiratory Diseases:
  • Forced expiratory volume (FEV1): \<50%.
  • Oxygen saturation: Resting SpO₂ \<88% on room air without supplemental oxygen.
  • CO2 retention: PaCO₂ \>50 mmHg.
  • Connective Tissue Disorders:
  • Severe systemic lupus erythematosus (SLE): Active lupus nephritis with GFR \<30 mL/min.
  • Scleroderma with severe pulmonary hypertension or FVC \<50% predicted.
  • Rheumatoid arthritis with severe cervical spine instability (atlantoaxial subluxation).
  • Severe Inflammatory Bowel Disease (IBD):
  • Severe Crohn's or ulcerative colitis flares with C-reactive protein (CRP) \>10 mg/L and hypoalbuminemia (Albumin \<2.5 g/dL).
  • Severe malnutrition: BMI \<18.5 kg/m² or Prealbumin \<10 mg/dL
  • Steroid dependency:
  • Chronic steroid use (\>20 mg prednisone daily) with no feasible taper pre-surgery.

Other

• Significant Uterine Pathology: Presence of large uterine fibroids, adenomyosis, or other intrauterine pathologies that would complicate the procedure or future pregnancy.
• Pregnancy: Patients who are currently pregnant are excluded from consideration for uterine transposition.
• Unsuitable for Ovarian Function Preservation: Women with signs of poor ovarian reserve, including:
  • FSH: \>10 IU/L
  • AMH: \<1 ng/mL
  • Estradiol: outside normal range.
• Non-Candidate for Fertility: Patients with contraindications to future pregnancy, such as severe uterine abnormalities or significant risk for pregnancy-related complications.
• Body Mass Index (BMI) ≥35.
• Absence of One of the Gonadal Vessels.

• Age: Women 18 - 40 years of age who wish to preserve their fertility.
• Malignancy: Diagnosis of pelvic malignancies that require radiotherapy, including:
  • Colon and rectal cancer with tumors.
  • Anal cancer.
  • Other pelvic malignancies that require administration of WPXRT.
• Desire for Fertility Preservation: The patient expresses a clear desire to preserve fertility and the ability to carry a pregnancy in the future.
• Preoperative Ovarian Function: The patient must have normal ovarian function, demonstrated by specific hormonal values, including:
  • Follicle-Stimulating Hormone (FSH): \<10 IU/L
  • Luteinizing Hormone (LH): within normal reference range for reproductive age (typically 1.5-8 IU/L in the early follicular phase).
  • Anti-Müllerian Hormone (AMH): \>1 ng/mL
  • Estradiol (E2): within the normal range for the follicular phase (usually 30-120 pg/mL).
• No Distant Metastasis: Absence of metastatic disease confirmed by imaging (CT, MRI, or PET scans).
• Body Mass Index (BMI) \< 35.
• Signed Informed Consent.