An experimental surgery is helping cancer survivors give birth

This week I want to tell you about an experimental surgical procedure that’s helping people have babies. Specifically, it’s helping people who have had treatment for bowel or rectal cancer.

Radiation and chemo can have pretty damaging side effects that mess up the uterus and ovaries. Surgeons are pioneering a potential solution: simply stitch those organs out of the way during cancer treatment. Once the treatment has finished, they can put the uterus—along with the ovaries and fallopian tubes—back into place.

It seems to work! Last week, a team in Switzerland shared news that a baby boy had been born after his mother had the procedure. Baby Lucien was the fifth baby to be born after the surgery and the first in Europe, says Daniela Huber, the gyno-oncologist who performed the operation. Since then, at least three others have been born, adds Reitan Ribeiro, the surgeon who pioneered the procedure. They told me the details.

Huber’s patient was 28 years old when a four-centimeter tumor was discovered in her rectum. Doctors at Sion Hospital in Switzerland, where Huber works, recommended a course of treatment that included multiple medications and radiotherapy—the use of beams of energy to shrink a tumor—before surgery to remove the tumor itself.

This kind of radiation can kill tumor cells, but it can also damage other organs in the pelvis, says Huber. That includes the ovaries and uterus. People who undergo these treatments can opt to freeze their eggs beforehand, but the harm caused to the uterus will mean they’ll never be able to carry a pregnancy, she adds. Damage to the lining of the uterus could make it difficult for a fertilized egg to implant there, and the muscles of the uterus are left unable to stretch, she says.

In this case, the woman decided that she did want to freeze her eggs. But it would have been difficult to use them further down the line—surrogacy is illegal in Switzerland.

Huber offered her an alternative.

She had been following the work of Ribeiro, a gynecologist oncologist formerly at the Erasto Gaertner Hospital in Curitiba, Brazil. There, Ribeiro had pioneered a new type of surgery that involved moving the uterus, fallopian tubes, and ovaries from their position in the pelvis and temporarily tucking them away in the upper abdomen, below the ribs.

Ribeiro and his colleagues published their first case report in 2017, describing a 26-year-old with a rectal tumor. (Ribeiro, who is now based at McGill University in Montreal, says the woman had been told by multiple doctors that her cancer treatment would destroy her fertility and had pleaded with him to find a way to preserve it.)

Huber remembers seeing Ribeiro present the case at a conference at the time. She immediately realized that her own patient was a candidate for the surgery, and that, as a surgeon who had performed many hysterectomies, she’d be able to do it herself. The patient agreed.

Huber’s colleagues at the hospital were nervous, she says. They’d never heard of the procedure before. “When I presented this idea to the general surgeon, he didn’t sleep for three days,” she tells me. After watching videos from Ribeiro’s team, however, he was convinced it was doable.

So before the patient’s cancer treatment was started, Huber and her colleagues performed the operation. The team literally stitched the organs to the abdominal wall. “It’s a delicate dissection,” says Huber, but she adds that “it’s not the most difficult procedure.” The surgery took two to three hours, she says. The stitches themselves were removed via small incisions around a week later. By that point, scar tissue had formed to create a lasting attachment.

The woman had two weeks to recover from the surgery before her cancer treatment began. That too was a success—within months, her tumor had shrunk so significantly that it couldn’t be seen on medical scans.

As a precaution, the medical team surgically removed the affected area of her colon. At the same time, they cut away the scar tissue holding the uterus, tubes, and ovaries in their new position and transferred the organs back into the pelvis.

Around eight months later, the woman stopped taking contraception. She got pregnant without IVF and had a mostly healthy pregnancy, says Huber. Around seven months into the pregnancy, there were signs that the fetus was not growing as expected. This might have been due to problems with the blood supply to the placenta, says Huber. Still, the baby was born healthy, she says.

Ribeiro says he has performed the surgery 16 times, and that teams in countries including the US, Peru, Israel, India, and Russia have performed it as well. Not every case has been published, but he thinks there may be around 40.

Since Baby Lucien was born last year, a sixth birth has been announced in Israel, says Huber. Ribeiro says he has heard of another two births since then, too. The most recent was to the first woman who had the procedure. She had a little girl a few months ago, he tells me.

No surgery is risk-free, and Huber points out there’s a chance that organs could be damaged during the procedure, or that a more developed cancer could spread. The uterus of one of Ribeiro’s patients failed following the surgery. Doctors are “still in the phase of collecting data to [create] a standardized procedure,” Huber says, but she hopes the surgery will offer more options to young people with some pelvic cancers. “I hope more young women could benefit from this procedure,” she says.

Ribeiro says the experience has taught him not to accept the status quo. “Everyone was saying … there was nothing to be done [about the loss of fertility in these cases],” he tells me. “We need to keep evolving and looking for different answers.”

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.