Surgery, Gastroenterology and Oncology

Cervical cancer is the fourth most common gynecological malignancy. It is a major health problem commonly affecting women in a young age. It is well known that the majority of cervical cancer cases are related to human papilloma virus. Therefore, in Europe the rate of cervical cancer is expected to decrease due to human papilloma virus vaccination (1-3). However, the discrepancy in cervical cancer cases is clearly seen between Eastern and Western European countries. Moreover, the estimated age-standardized incidence rate of cervical cancer is the highest in Bulgaria among all European countries (1-3). Surgery is the standard treatment therapy in early stages, whereas concurrent pelvic radiotherapy combined with chemotherapy is the preferable treatment modality in advanced cases (4). Annual cases of Bulgaria are one of the highest in Europe. The five-year relative overall survival for women with cervical cancer remains unacceptable low in Bulgaria. The reasons for this epidemiology crisis are due to the low vaccination rate (less than 6% for the first dose) and lack of population-based screening program. Approximately, one fifth of the patients are diagnosed between the age of 35 and 44 year. The incidence of patients diagnosed at advanced stage of the disease is expecting to high (1-3). Ovarian transposition could be an option for inoperable patients with advanced cervical cancer, which are referred to definitive chemoradiation. Ovarian transposition will probably prevent menopausal induced osteoporosis, cardiovascular morbidity and vaginal atrophy. Additionally, OT is an alternative method for patient with advanced cervical cancer desiring pregnancy. Herein, we described step by step laparoscopic ovarian transposition in cases of advanced cervical cancer. Patient selection criteria, surgical considerations during the procedure and postoperative complications are also highlighted in detail (5). Laparoscopic ovarian transposition is superior to the laparotomy, as it has fast recovery rate and reduced hospital stay. Therefore, the definitive treatment will not be delayed. Although ovarian transposition is not a curative procedure, it could improve the quality of life of patients with advanced cervical cancer referred to definitive chemoradiation.

Conflict of interest

All authors declare no conflict of interest .

Funding

No funding sources.

Ethical statement

The patient signed the inform concern.

References

1. Cancer Tomorrow. ((accessed on 1 April 2022)). Available online: https://gco.iarc.fr/tomorrow/en/dataviz/isotype?types=0&sexes=0&mode=population&group_populations=1&multiple_populations=1&multiple_cancers=0&cancers=23&populations=908&single_unit=5000

2. Bulgaria Source: Globocan Incidence, Mortality and Prevalence by Cancer Site. ((accessed on 1 December 2022)). Available online: https://gco.iarc.fr/today/data/factsheets/populations/100-bulgaria-fact-sheets.pdf

3. Yordanov A, Vasileva-Slaveva M, Galai N, Faraggi D, Kubelac MP, Tripac-Iacovleva I, et al. Cancer of the Cervix in Bulgaria: Epidemiology of a Crisis. Healthcare (Basel). 2023;11(3):318.

4. Cibula D, Raspollini MR, Planchamp F, Centeno C, Chargari C, Felix A, et al. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer – Update 2023. Int J Gynecol Cancer. 2023;33(5):649-666.

5. Laios A, Duarte Portela S, Papadopoulou A, Gallos ID, Otify M, Ind T. Ovarian transposition and cervical cancer. Best Pract Res Clin Obstet Gynaecol. 2021;75:37-53.