Inclusion Criteria:
1. Age: Women 18 - 40 years of age who wish to preserve their fertility.
2. Malignancy: Diagnosis of pelvic malignancies that require radiotherapy, including:
1. Colon and rectal cancer with tumors.
2. Anal cancer.
3. Other pelvic malignancies that require administration of WPXRT.
3. Desire for Fertility Preservation: The patient expresses a clear desire to preserve fertility and the ability to carry a pregnancy in the future.
4. Preoperative Ovarian Function: The patient must have normal ovarian function, demonstrated by specific hormonal values, including:
1. Follicle-Stimulating Hormone (FSH): <10 IU/L
2. Luteinizing Hormone (LH): within normal reference range for reproductive age (typically 1.5-8 IU/L in the early follicular phase).
3. Anti-Müllerian Hormone (AMH): >1 ng/mL
4. Estradiol (E2): within the normal range for the follicular phase (usually 30-120 pg/mL).
5. No Distant Metastasis: Absence of metastatic disease confirmed by imaging (CT, MRI, or PET scans).
6. Body Mass Index (BMI) < 35.
7. Signed Informed Consent.
Exclusion Criteria:
1. Advanced Cancer Stage: Patients with locally advanced or metastatic disease.
2. Significant Uterine Pathology: Presence of large uterine fibroids, adenomyosis, or other intrauterine pathologies that would complicate the procedure or future pregnancy.
3. Poor General Health or Comorbidities: Severe medical conditions that contraindicate surgical intervention, that include but not limited to:
1. Recent (within 6 months) myocardial infarction (MI).
2. Ejection fraction (EF): EF <30%.
3. Uncontrolled hypertension: Systolic BP >180 mmHg or Diastolic BP >110 mmHg prior to surgery.
4. Severe aortic stenosis: Valve area <1 cm² with symptomatic status.
- Uncontrolled Diabetes Mellitus:
1. Hemoglobin A1c (HbA1c) > 9%
2. Persistent fasting glucose >250 mg/dL preoperatively despite optimization.
- Severe Respiratory Diseases:
1. Forced expiratory volume (FEV1): <50%.
2. Oxygen saturation: Resting SpO₂ <88% on room air without supplemental oxygen.
3. CO2 retention: PaCO₂ >50 mmHg.
- Connective Tissue Disorders:
1. Severe systemic lupus erythematosus (SLE): Active lupus nephritis with GFR <30 mL/min.
2. Scleroderma with severe pulmonary hypertension or FVC <50% predicted.
3. Rheumatoid arthritis with severe cervical spine instability (atlantoaxial subluxation).
- Severe Inflammatory Bowel Disease (IBD):
1. Severe Crohn's or ulcerative colitis flares with C-reactive protein (CRP) >10 mg/L and hypoalbuminemia (Albumin <2.5 g/dL).
2. Severe malnutrition: BMI <18.5 kg/m² or Prealbumin <10 mg/dL
1. Chronic steroid use (>20 mg prednisone daily) with no feasible taper pre-surgery.
4. Prior Pelvic Radiotherapy.
5. Prior history of systemic chemotherapy and immunotherapy that resulted in significant toxicity and residual deficit.
6. Pregnancy: Patients who are currently pregnant are excluded from consideration for uterine transposition.
7. 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.
8. Non-Candidate for Fertility: Patients with contraindications to future pregnancy, such as severe uterine abnormalities or significant risk for pregnancy-related complications.
9. Body Mass Index (BMI) ≥35.
10. Absence of One of the Gonadal Vessels.
11. Other unlisted conditions or diagnoses that, in the opinion of the primary investigator, render the patient an unsuitable candidate for uteroovarian transposition.