Article Data

  • Views 756
  • Dowloads 137

Original Research

Open Access

Beyond bladder dysfunction: assessing the full impact of radical hysterectomy on cervical cancer patients

  • María Alonso-Espías1,*,
  • Marcos Alonso-García2
  • Virginia García-Pineda1
  • Myriam Gracia1
  • Jaime Siegrist1
  • María Dolores Diestro1
  • Alicia Hernández1
  • Ignacio Zapardiel1

1Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain

2Directorate General of Public Health, Regional Ministry of Health of Madrid, 28014 Madrid, Spain

DOI: 10.22514/ejgo.2023.099 Vol.44,Issue 6,December 2023 pp.60-66

Submitted: 30 March 2023 Accepted: 12 July 2023

Published: 15 December 2023

*Corresponding Author(s): María Alonso-Espías E-mail:


Although bladder dysfunction is the most commonly reported complication after radical hysterectomy, there are other significant complications associated with cervical cancer surgery that have received less attention in the literature. This study aims to investigate the frequency of non-functional complications related to radical hysterectomy and identify significantly related risk factors associated with their occurrence. A retrospective study was conducted on consecutive patients diagnosed with early-stage cervical cancer who underwent radical hysterectomy at La Paz University Hospital between 2005 and 2019. The study collected data on intraoperative, short-term and long-term complications, and a multivariate analysis was performed to identify potential predictors of surgical complications. Of the 111 patients included in the study, 11.7%experienced intraoperative complications. Multivariate analysis indicated that the presence of microscopic parametrial involvement was significantly associated with an increased risk of intraoperative complications (Odds ratio (OR) = 16.7; 95% Confindent interval (CI): 1.4–195). Urological complications were the most common short-term complications, affecting 14.4% of the patients. On the other hand, lymphedema was the most frequent long-term complication, with a prevalence of 18%. In univariate analysis, the International Federation of Gynecology and Obstetrics (FIGO) stage tended to be associated (p = 0.05) with postoperative complications. Furthermore, the performance of selective sentinel lymph node biopsy instead of lymphadenectomy was associated with a reduced incidence of lymphedema, from 18% to 3.8%. While urological complications are the most common after radical hysterectomy, other complications, such as genitourinary fistula or lymphedema, while less frequent, are also significant due to their negative impact on patients’ quality of life. Thus, an accurate preoperative diagnosis is essential to prevent surgical complications.


Hysterectomy; Intraoperative complications; Postoperative complications; Uterine cervical neoplasms

Cite and Share

María Alonso-Espías,Marcos Alonso-García,Virginia García-Pineda,Myriam Gracia,Jaime Siegrist,María Dolores Diestro,Alicia Hernández,Ignacio Zapardiel. Beyond bladder dysfunction: assessing the full impact of radical hysterectomy on cervical cancer patients. European Journal of Gynaecological Oncology. 2023. 44(6);60-66.


[1] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021; 71: 209–249.

[2] Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri: 2021 update. International Journal of Gynecology & Obstetrics. 2021; 155: 28–44.

[3] Vu M, Yu J, Awolude OA, Chuang L. Cervical cancer worldwide. Current Problems in Cancer. 2018; 42: 457–465.

[4] Cibula D, Raspollini MR, Planchamp F, Centeno C, Chargari C, Felix A, et al. ESGO/ESTRO/ESP guidelines for the management of patients with cervical cancer—Update 2023. International Journal of Gynecologic Cancer. 2023; 33: 649–666.

[5] Mann WJ. Radical hysterectomy. 2022. Available at: (Accessed: 14 March 2022).

[6] Querleu D, Cibula D, Abu-Rustum NR. 2017 update on the Querleu-Morrow classification of radical hysterectomy. Annals of Surgical Oncology. 2017; 24: 3406–3412.

[7] Stanca M, Căpîlna DM, Trâmbițaș C, Căpîlna ME. The overall quality of life and oncological outcomes following radical hysterectomy in cervical cancer survivors results from a large long-term single-institution study. Cancers. 2022; 14: 317.

[8] Duska RL. Overview of approach of cervical cancer survivors. 2022. Available at: (Accessed: 07 April 2022).

[9] Zapardiel I, Kocian R, Köhler C, Klat J, Germanova A, Jacob A, et al. Voiding recovery after radical parametrectomy in cervical cancer patients: an international prospective multicentre trial—SENTIX. Gynecologic Oncology. 2021; 160: 729–734.

[10] Zapardiel I, Ceccaroni M, Minig L, Halaska MJ, Fujii S. Avascular spaces in radical hysterectomy. International Journal of Gynecologic Cancer. 2023; 33: 285–292.

[11] Jing H, Xiuhong W, Ying Y, Xiyun C, Deping L, Changmei S, et al. Complications of radical hysterectomy with pelvic lymph node dissection for cervical cancer: a 10-year single-centre clinical observational study. BMC Cancer. 2022; 22: 1286.

[12] Nam J, Park J. Fertility-sparing surgery for young women with early-stage epithelial ovarian cancer. Gynecologic and Obstetric Investigation. 2013; 76: 14–24.

[13] Guo J, Yang L, Cai J, Xu L, Min J, Shen Y, et al. Laparoscopic procedure compared with open radical hysterectomy with pelvic lymphadenectomy in early cervical cancer: a retrospective study. OncoTargets and Therapy. 2018; 11: 5903–5908.

[14] Wenzel HHB, Kruitwagen RFPM, Nijman HW, Bekkers RLM, Gorp T, Kroon CD, et al. Short‐term surgical complications after radical hysterectomy—a nationwide cohort study. Acta Obstetricia et Gynecologica Scandinavica. 2020; 99: 925–932.

[15] Hwang JH, Kim BW. Laparoscopic radical hysterectomy has higher risk of perioperative urologic complication than abdominal radical hysterectomy: a meta-analysis of 38 studies. Surgical Endoscopy. 2020; 34: 1509–1521.

[16] Hwang JH, Lim MC, Joung JY, Seo S, Kang S, Seo HK, et al. Urologic complications of laparoscopic radical hysterectomy and lymphadenectomy. International Urogynecology Journal. 2012; 23: 1605–1611.

[17] Nam JH, Park JY, Kim DY, Kim JH, Kim YM, Kim YT. Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study. Annals of Oncology. 2012; 23: 903–911.

[18] Liu P, Liang C, Lu A, Chen X, Liang W, Li D, et al. Risk factors and long-term impact of urologic complications during radical hysterectomy for cervical cancer in China, 2004–2016. Gynecologic Oncology. 2020; 158: 294–302.

[19] Liang C, Liu P, Cui Z, Liang Z, Bin X, Lang J, et al. Effect of laparoscopic versus abdominal radical hysterectomy on major surgical complications in women with stage IA–IIB cervical cancer in China, 2004–2015. Gynecologic Oncology. 2020; 156: 115–123.

[20] Hwang JH. Urologic complication in laparoscopic radical hysterectomy: meta-analysis of 20 studies. European Journal of Cancer. 2012; 48: 3177–3185.

[21] Abrão FS, Breitbarg RC, Oliveira AT, Vasconcelos FA. Complications of surgical treatment of cervical carcinoma. Brazilian Journal of Medical and Biological Research. 1997; 30: 29–33.

[22] Balaya V, Mathevet P, Magaud L, Delomenie M, Bonsang-Kitzis H, Ngô C, et al. Predictive factors of severe perioperative morbidity of radical hysterectomy with lymphadenectomy in early-stage cervical cancer: a French prospective multicentric cohort of 248 patients. European Journal of Surgical Oncology. 2019; 45: 650–658.

[23] Dessources K, Aviki E, Leitao Jr MM. Lower extremity lymphedema in patients with gynecologic malignancies. International Journal of Gynecologic Cancer. 2020; 30: 252–260.

[24] Biglia N, Librino A, Ottino MC, Panuccio E, Daniele A, Chahin A. Lower limb lymphedema and neurological complications after lymphadenectomy for gynecological cancer. International Journal of Gynecological Cancer. 2015; 25: 521–525.

[25] Borčinová M, Ragosch V, Jarkovský J, Bajsová S, Pilka R, Glickman A, et al. Challenges in lower limb lymphoedema assessment based on limb volume change: lessons learnt from the SENTIX prospective multicentre study. Gynecologic Oncology. 2022; 164: 76–84.

[26] Cibula D, Kocian R, Plaikner A, Jarkovsky J, Klat J, Zapardiel I, et al. Sentinel lymph node mapping and intraoperative assessment in a prospective, international, multicentre, observational trial of patients with cervical cancer: the SENTIX trial. European Journal of Cancer. 2020; 137: 69–80.

[27] Niikura H, Okamoto S, Otsuki T, Yoshinaga K, Utsunomiya H, Nagase S, et al. Prospective study of sentinel lymph node biopsy without further pelvic lymphadenectomy in patients with sentinel lymph node-negative cervical cancer. International Journal of Gynecologic Cancer. 2012; 22: 1244–1250.

[28] Tu H, Huang H, Xian B, Li J, Wang P, Zhao W, et al. Sentinel lymph node biopsy versus pelvic lymphadenectomy in early-stage cervical cancer: a multi-center randomized trial (PHENIX/CSEM 010). International Journal of Gynecologic Cancer. 2020; 30: 1829–1833.

[29] Lecuru FR, McCormack M, Hillemanns P, Anota A, Leitao M, Mathevet P, et al. SENTICOL III: an international validation study of sentinel node biopsy in early cervical cancer. a GINECO, ENGOT, GCIG and multicenter study. International Journal of Gynecologic Cancer. 2019; 29: 829–834.

[30] Nakamura K, Kitahara Y, Satoh T, Takei Y, Takano M, Nagao S, et al. Analysis of the effect of adjuvant radiotherapy on outcomes and complications after radical hysterectomy in FIGO stage IB1 cervical cancer patients with intermediate risk factors (GOTIC Study). World Journal of Surgical Oncology. 2016; 14: 173.

[31] Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, et al. Randomised study of radical surgery versus radiotherapy for stage Ib–IIa cervical cancer. the Lancet. 1997; 350: 535–540.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time