Making History: Uterine Transposition Preserves Fertility in Cancer Patient

When Courtney De Stefano was told in November of 2023 that she had vaginal cancer, the otherwise healthy 32-year-old focused on what was most important: survival. Then she realized the dream she had of someday having children might never materialize.

Before she could even voice her concern, however, Baptist Health Miami Cancer Institute physicians already had a proposal. They suggested she undergo a new and rare procedure known as uterine transposition to protect her uterus and ovaries from the fertility damage that is a common side effect of pelvic radiation therapy.

(Watch now: When Courtney De Stefano learned she had vaginal cancer, she worried she might never have children. But a new procedure at Baptist Health Miami Cancer Institute protected her uterus and ovaries from fertility damage, a common side effect of pelvic radiation therapy. Video by Alcyene de Almeida Rodrigues.)

“It was outside-the-box thinking, which is something we do quite well here,” says John Diaz, M.D., chief of clinical oncology at the Institute and director of robotic surgery at Baptist Health. “Only select centers around the country are offering this to patients, because it takes a multidisciplinary approach with a team of experts.”

Even though the procedure seemed futuristic, Ms. De Stefano jumped at the opportunity to be among the first to have the surgery. “I’ve worked with kids throughout my career,” says the regional manager for Miami-Dade County Parks and Recreation. “I’ve just always had a connection with children and have always wanted children of my own.”

To prepare for the procedure, Ms. De Stefano first had surgery on Nov. 20, 2023, to remove her cancerous tumor. After healing, she was put into temporary menopause with medication. She underwent the still-investigational uterine transposition on Feb. 28, 2024.

A move that safeguards the organs

During the robotic-assisted surgery, through tiny incisions, surgeons moved her uterus and ovaries from their normal position in the pelvis to an area higher in the abdomen, maintaining a healthy blood supply. The organs were sutured in place so that Ms. De Stefano could safely continue her treatment, which included radiation and chemotherapy.

“Technically, the procedure is similar to a robotic hysterectomy, except we are preserving the uterus and ovaries,” Dr. Diaz explains.

John Diaz, M.D., chief of clinical oncology at at Baptist Health Miami Cancer Institute and director of robotic surgery at Baptist Health

As Florida’s only member of the Memorial Sloan Kettering Cancer Alliance, Miami Cancer Institute collaborates with the New York-based cancer center on oncology initiatives including new procedures and clinical trials. “Because I had not performed a uterine transposition before, I reached out to my mentors and colleagues there and Courtney and I traveled to New York for the first phase of the procedure.”

In the operating room, Dr. Diaz worked side-by-side with Mario Leitao, M.D., a gynecologic surgeon at Memorial Sloan Kettering who was part of the first U.S. team to perform a uterine transposition. It was also a learning experience for Dr. Leitao, who had used the technique for women with colorectal cancer, but not a gynecologic cancer.

Collaboration moves care forward

Ms. De Stefano was impressed by the speed at which Dr. Diaz pulled her treatment plan together. “From the moment he first sat down with me to explain my diagnosis, Dr. Diaz was immediately on the phone, texting colleagues so that I would get the best treatment. He is very caring, very professional, and he made me feel comfortable even knowing that I was going to have a very unusual surgery.”

The ability to work quickly and with others around the globe (Dr. Diaz even spoke to the Brazilian surgeon who performed the first uterine transposition in the world), comes partially from Miami Cancer Institute’s reputation for innovation and the fact that Baptist Health’s robotic surgery program is among the busiest and most experienced in the country.

On July 16, at Baptist Health South Miami Hospital, Ms. De Stefano underwent the second phase of the procedure, to return her uterus and ovaries back to their original position. This time, Dr. Diaz was joined by Dr. Leitao.

“My body went through a lot,” Ms. De Stefano says. “The treatment was probably rougher than the surgeries.” Making things more stressful, her father was also diagnosed with cancer while she was being treated. Having the help of family and friends — particularly her mother who she calls her support system — made a huge difference in her daily life.

Ms. De Stefano and her father are both doing well. A Thanksgiving baby herself, she looks forward to this Thanksgiving, when she’ll turn 34. “I watch every sunset. I appreciate the little things. I always have, but this has taken it to another level. I want to live my life to the fullest. As difficult as everything has been, I’m grateful that I can educate people about this and pave the way for more women who might benefit in the future.”

John Diaz, M.D., with patient Courtney De Stefano following her treatment for vaginal cancer at Baptist Health Miami Cancer Institute

The future

The success of Ms. De Stefano’s treatment will be determined in two ways, Dr. Diaz says. “Our priority is oncologic success. We treated her cancer, there is no evidence of cancer and she is doing very well. We are looking for small goals now, such as the return to normal menstrual function. Ultimately, we hope that one day she’ll have a healthy and happy baby.”

A second Miami Cancer Institute patient has also had uterine transposition to preserve her fertility during treatment for colorectal cancer. Gynecological surgical oncologist Jean-Marie Stephan, M.D., joined by Dr. Diaz, was the first to perform the first phase of the procedure at a Baptist Health hospital.

With many women delaying childbirth until later in life and an increase in cancer diagnoses in younger women, the fertility discussion is one that occurs many times a day at Miami Cancer Institute. Multiple options to preserve fertility are available to men and women going through cancer treatment, including freezing eggs and embryos, sperm banking and testicular shielding in men, the use of donor eggs and embryos, surrogacy and adoption.