Ovarian preservation and transposition in cervical cancer: A Retrospective Cohort Study with Long-term Oncological Follow-up

Background Ovarian transposition preserves endocrine function in premenopausal women with cervical cancer undergoing pelvic radiotherapy, but its effect on long-term oncological outcomes compared with salpingo-oophorectomy remains uncertain. Methods We performed a retrospective cohort study of patients with histologically confirmed cervical adenocarcinoma or squamous cell carcinoma who underwent ovarian transposition (OT, n = 44) or salpingo-oophorectomy (SO, n = 52) during radical surgery, with follow-up extending to approximately 10 years. Recurrence-free survival (RFS) and overall survival (OS) were compared by Kaplan-Meier analysis with log-rank, Breslow, and Tarone-Ware tests. Cox regression assessed the association between surgical approach and recurrence, adjusted for clinicopathological covariates. Results The final cohort comprised 96 patients. Patients undergoing SO had significantly longer RFS than those undergoing OT (log-rank P = 0.046; Breslow P = 0.003; Tarone-Ware P = 0.009). On multivariable Cox regression, SO remained independently associated with a 59% lower hazard of recurrence than OT (adjusted HR, 0.414; 95% CI, 0.197–0.872; P = 0.020). Among 39 patients with recurrence (22 OT, 17 SO), non-pelvic recurrence was more frequent after OT (81.8% vs. 52.9%), though not statistically significant (P = 0.053). In the FIGO stage III subgroup, median RFS was 35 months after OT versus 120 months after SO (P = 0.059). Conclusions Ovarian transposition was associated with shorter recurrence-free survival than salpingo-oophorectomy, independent of measured clinicopathological factors. Given the retrospective, single-center design, these findings require confirmation in larger prospective studies before informing counseling on fertility- and endocrine-preserving surgery.