Quick answer
Pelvic radiotherapy treats cervical and rectal cancer effectively and sterilises the patient as a side effect: the ovaries are exquisitely radiosensitive, and the uterus is damaged at doses well below the tumoricidal range. Egg and embryo freezing protects the gametes but not the womb, and surrogacy is illegal in China. Uterine transposition solves both: the uterus and ovaries are surgically lifted out of the pelvis, above the radiation field, and returned afterwards. Peking University Third Hospital performed China's first such procedure in a 25-year-old with low rectal cancer, and replaced the organs after more than a year — the first case internationally with an interval that long [1][2][5].
Key takeaways
- Patient: 25 years old, diagnosed with low rectal adenocarcinoma in July 2024, requiring neoadjuvant chemoradiotherapy [1][5].
- Team: Guo Hongyan of gynaecology with Song Xueling of reproductive medicine, plus general surgery, radiation oncology and anaesthesia [1][4].
- Stage one, December 2024: uterus and both ovaries transposed out of the pelvic radiation field [1][6].
- She then completed radiotherapy and multiple chemotherapy cycles over more than a year [6].
- Stage two, September 2025: repositioning; menses returned within about two months with normal blood flow on ultrasound [2][6].
Why the two operations are different problems
Transposition is a vascular operation, not a simple repositioning. The uterus survives on the uterine arteries, and the ovaries on the infundibulopelvic and ovarian vessels; the surgeon must mobilise them far enough to clear the radiation field while preserving that blood supply and avoiding torsion. Replacing them later is harder still, because adhesions form and the anatomy has changed [2][3].
The interval is the novel element. Published transposition series typically reposition within weeks to a few months; here chemoradiotherapy ran for more than a year before the second operation, and the graft still recovered. That extends the technique to regimens with long treatment courses [6].
What has been proven, and what has not
What is proven is that the organs survived, hormone function resumed and menstruation returned — the physiological prerequisites for pregnancy. Restoration of menses is not the same as proven fertility [1][2].
No pregnancy has yet been reported after this case, and radiotherapy plus surgery may still impair implantation, uterine volume and vascularity. Case reports of novel procedures are selected successes; the technique's complication rate — torsion, ischaemia, recurrence risk from delaying cancer treatment, and the possibility that transposition interferes with radiotherapy planning — will only emerge from series. The procedure also adds an operation before cancer treatment, which is only justified when the oncological timeline allows it [3][5].
The condition in context: cancer treatment and fertility
Young women with pelvic malignancy face a choice that is often presented as binary — cure or fertility.
| Region | What the data shows | Source |
|---|---|---|
| Radiation sensitivity | Ovaries are damaged at very low doses; the uterus at higher but still sub-tumour doses [3]. | Obstetrics and Gynaecology Network [3] |
| International context | Uterine transposition is described in ACOG literature and a 2025 review in Obstetrics & Gynecology [3]. | Obstetrics and Gynaecology Network [3] |
| Legal setting | Surrogacy is not permitted in China, so preserving the uterus matters more than in some jurisdictions [5]. | Guangming Daily via hospital [5] |
Because uterine factor infertility has no legal workaround in China, a technique that preserves the womb addresses a need that gamete freezing cannot [5].
Why it matters
| For the patient | What the report suggests | Source |
|---|---|---|
| Both organs preserved | Fertility and endocrine function, not just eggs [2]. | [2] |
| Long intervals feasible | First case internationally with over a year between operations [6]. | [6] |
| Caution | One case; no pregnancy reported yet [1][2]. | [1][2] |
Availability and limits
- This is an editorial summary of a hospital case report, not a treatment offer [1][2].
- Requires a multidisciplinary team and specific surgical expertise [4].
- No pregnancy outcome has been reported in this case [2].
- Added surgery must not delay oncological treatment [3].
- Long-term uterine function after pelvic radiotherapy remains uncertain [5].
What to ask before booking
| Question | Why it matters |
|---|---|
| Will radiotherapy cover my uterus, and at what dose? | Field and dose determine whether transposition helps [3]. |
| Can the operation be done without delaying treatment? | Oncological timing takes precedence [5]. |
| Which department handles foreign patients, and in what language? | Peking University Third Hospital is a working hospital we do not book; confirm international-department coordination and language support. |
| What is the plan if repositioning is not possible? | The fallback is gamete or embryo freezing [2]. |
Questions patients ask
What was done?
China's first uterine transposition: the uterus and both ovaries were moved out of the pelvic radiation field before chemoradiotherapy for low rectal cancer, then repositioned after treatment finished [1][2].
Did it work?
Menses returned within about two months of repositioning, with normal uterine and ovarian blood flow on ultrasound. No pregnancy has been reported yet [2][6].
Why not just freeze eggs?
Egg freezing preserves gametes but not the uterus, and surrogacy is illegal in China [5].
What is new about this case?
It is the first reported case internationally with an interval of more than a year between transposition and repositioning [6].
Is this relevant to international patients?
It is useful context for China's fertility preservation practice. The hospital is a working hospital we do not book — contact its international department directly [1].