Surgical Options Exist to Preserve Fertility: But a Lack of Awareness May Lead Some Cancer Patients to Undergo Unnecessary Sterilization

Article excerpt

SAN ANTONIO -- Although there are options for preserving fertility in cancer patients, lack of awareness among patients and oncologists too often results in unnecessary sterilization, Dr. Togas Tulandi said at the annual meeting of the American Society for Reproductive Medicine.

One such option is a technique called laparoscopic ovarian transposition, which he first reported in 1998. The procedure has resulted in one spontaneous pregnancy, said Dr. Tulandi, professor of obstetrics and gynecology and the Milton Leong Chair in Reproductive Medicine at McGill University, Montreal.

"This technique is suitable for patients receiving radiation therapy alone. The ovary is moved out of the field of danger, but remains intact with the fallopian tube, thus retaining the potential for a spontaneous pregnancy." he said, noting that he has performed several of these operations.

Indeed, with increasing cancer survival rates, fertility specialists and oncologists need to work together.

"We have to talk to each other now," agreed Dr. Guiseppe Del Priore, a gynecologic oncologist with Albert Einstein College of Medicine in New York.

Dr. Del Priore has performed a technique called abdominal radical trachelectomy (ART) that avoids the need for hysterectomy in cervical cancer patients. "It is like vaginal radical trachelectomy in that it removes the cervix while retaining the fundus, but the difference is that because of the abdominal access, ART is easy to do," he explained.

The majority of cervical cancer patients are treated with hysterectomy even though they are of reproductive age, because the only alternative--vaginal radical trachelectomy--is too tricky for many physicians, he said.

"The vaginal approach requires significant skills, like vaginal ureterolysis and laparoscopic lymph node dissection. This is not a good technique for the physician who is unfamiliar with the vaginal approach, or for a tumor that is too large, or a patient whose anatomy doesn't allow it," Dr. Del Priore said.

ART uses the same technique as a radical hysterectomy with one modification: The connection between the gonadal vessels and the fundus is maintained, ensuring a blood supply. …


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