The Hospital del Mar in Barcelona has performed the first uterus transplant in Spain on a patient diagnosed with locally advanced rectal cancer. This technique allows women with a tumor in the pelvic area to retain the possibility of becoming mothers and, at the same time, avoid early menopause, since it protects both the uterus and the ovaries from the side effects of radiotherapy. The procedure, which can be understood as an autologous transplant, consists of two interventions: first, the uterus and ovaries are transferred inside the abdomen, above the navel, so that they are out of the radiation field, and in a second operation, when the oncology treatment is over and the organs have returned to their normal position.
The Hospital del Mar has paved the way in Catalonia and the country with a procedure that has few precedents in the world, around twenty operations, after which some women have been able to become mothers despite having undergone radiotherapy sessions for tumors in the pelvic area. The first baby was born in Brazil in 2022.
The patient operated on at Hospital del Mar, a 36-year-old woman, was operated on for the first time in November 2023 and the second was performed in June, when she finished oncology treatment, coinciding with a rectal tumor resection. Both interventions were performed using robotic surgery.a To minimize its impact. Now, the patient can, if she wants, be a mother.
Speaking to ACN, Esther Miralbecks, an associate physician in the obstetrics and gynecology service, points out that at the time of cancer diagnosis it can be difficult to think about whether you want to have children, but that is before radiotherapy is applied when uterine replacement should be considered because the doses used to treat rectal cancer cause irreversible damage to the uterus, causing infertility, and to the ovaries, with early menopause in young patients.
She also points out that the incidence of rectal cancer in young women is increasing and that this technique is supposed to give them hope if their potential desire to become a mother has not yet been fulfilled.
The uterus transplant approach involves moving both the uterus and ovaries to the abdomen. The uterus maintains blood flow through the ovaries while treatment is being performed against the tumor.
“It’s about changing the anatomy of an organ in the pelvis and putting it in another place,” says Dr. Gemma Mancebo, head of the obstetrics and gynecology service, in statements to the hospital. “We leave it with the blood vessels it needs to survive, and once the oncology treatment is complete, we put it back in its natural place.”
In the process of identifying patients who can benefit from this procedure, the gastroenterology services are involved; general surgery through the Department of Colorectal Surgery; medical oncology and radiation oncology.
The Barcelona Hospital has created a department, with a prominent role for the case nurse, to refer women with a pelvic tumor who will need treatment with chemotherapy and radiotherapy and assess whether they can benefit from this technique, without any delay. In starting cancer treatment, the medical team studies the size of the tumor and whether it has affected the uterus or ovaries.
For women aged 40 and under, the option of protecting the uterus and ovaries is offered to preserve the possibility of pregnancy. For those under 47, only the ovaries are replaced to protect them from premature menopause. At Hospital del Mar, ovarian transplantation has already been offered and performed to prevent premature menopause in young patients with cervical cancer.
Once the second surgery is performed and the oncology treatment is completed, the patient can consider pregnancy if she wishes. In this case, in vitro fertilization is recommended due to the potential toxicity of the chemotherapy used against the tumor on the ovaries and by cesarean section at the time of delivery.
Ability to think about quality of life after cancer
The priority is to treat the cancer patient, but the increase in survival rates, linked to advances in treatments in recent years and early diagnosis, means that medical teams are increasingly aware of how to limit the consequences of the disease and improve the quality of life. During the oncology process and in the coming years, while also paying attention to sexual and reproductive health.
“As a gynecologic oncologist, when you see patients and see side effects, you wonder what you can do to improve their quality of life,” explains Dr. Miralbecks, who is part of the gynecologic oncology unit. He adds that they also listen to patients through focus groups to learn directly about their needs.
The Gynecology and Obstetrics Service of the Hospital del Mar has launched other initiatives in this regard, such as specialized consultations for women who have suffered from gynecological diseases or breast cancer and who offer fractional CO2 laser treatment to help restore lost elasticity and lubrication in the vagina and improve sexual health.
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