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Table 1 Characteristics of studies

From: Outcomes of ovarian transposition in gynaecological cancers; a systematic review and meta-analysis

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

  1. sc = Subcutaneous.
  2. NR = Not reported.
  3. OT = Ovarian transposition.