International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · 2026
Early post-operative complications after fertility-sparing surgery for cervical carcinoma: a retrospective study of a centralized national cohort of 127 consecutive women.
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Hagen Kristine Krüger, Eyjolfsdottir Brynhildur, Dahl Gunn Fallås, Wang Yun, Lund Kjersti Vassmo, Nordskar Nina Jebens, Sert Hakan, Sletten Elise Thoresen, Gausel Katarina, Sugulle Meryam, Staff Anne Cathrine, Hagen Milada, Eriksson Ane Gerda Z
Аннотация
OBJECTIVE: The extent of surgical radicality in fertility-sparing treatment for early-stage cervical carcinoma has evolved, reflecting global efforts to reduce surgical morbidity while preserving oncologic safety. We aimed to describe and compare 30-day post-operative complications after modified radical vaginal trachelectomy, simple vaginal trachelectomy, and conization with nodal assessment in a national centralized cohort of women with cervical carcinoma ≤2 cm.
METHODS: We conducted a national, retrospective descriptive cohort study of 127 consecutive patients who underwent fertility-sparing surgery for early-stage cervical carcinoma with tumors ≤2 cm between 2010 and 2021 at the Norwegian Radium Hospital. Surgical approaches included modified radical vaginal trachelectomy, simple vaginal trachelectomy, or conization with laparoscopic nodal assessment. Post-operative complications were retrospectively graded using the Accordion Severity Classification of Post-operative Complications: Expanded classification. Descriptive statistics were used for analysis.
RESULTS: Among 127 patients, the majority experienced no post-operative complications (n = 104, 82%). Minor complications (grades 1-2) were observed in 10 of 127 patients (8%), while 13 of 127 patients (10%) experienced severe complications (grades 3-4). Of these, 3 were related to lymphadenectomy, while 10 of 13 were cases of post-procedural cervical hemorrhage managed either with vaginal packing, electrocautery, suturing and/or local hemostatic agents. Seven of 10 hemorrhagic events occurred during hospitalization after primary surgery. No procedure-related deaths occurred. Severe complications (grades 3-4) occurred in 3 of 36 patients after modified radical vaginal trachelectomy (8%, 95% confidence interval 2%-23%), 5 of 37 after simple vaginal trachelectomy (14%, 95% confidence interval 5%-29%), and 5 of 54 after conization (9%, 95% confidence interval 3%-20%), with no statistically significant difference between groups (p = .62).
CONCLUSION: Cervical hemorrhage was the most common severe post-operative complication across all 3 surgical approaches, typically occurring within the first 48 hours after surgery. This finding highlights the importance of careful perioperative hemostatic management and pre-operative counseling in fertility-sparing cervical surgery.
METHODS: We conducted a national, retrospective descriptive cohort study of 127 consecutive patients who underwent fertility-sparing surgery for early-stage cervical carcinoma with tumors ≤2 cm between 2010 and 2021 at the Norwegian Radium Hospital. Surgical approaches included modified radical vaginal trachelectomy, simple vaginal trachelectomy, or conization with laparoscopic nodal assessment. Post-operative complications were retrospectively graded using the Accordion Severity Classification of Post-operative Complications: Expanded classification. Descriptive statistics were used for analysis.
RESULTS: Among 127 patients, the majority experienced no post-operative complications (n = 104, 82%). Minor complications (grades 1-2) were observed in 10 of 127 patients (8%), while 13 of 127 patients (10%) experienced severe complications (grades 3-4). Of these, 3 were related to lymphadenectomy, while 10 of 13 were cases of post-procedural cervical hemorrhage managed either with vaginal packing, electrocautery, suturing and/or local hemostatic agents. Seven of 10 hemorrhagic events occurred during hospitalization after primary surgery. No procedure-related deaths occurred. Severe complications (grades 3-4) occurred in 3 of 36 patients after modified radical vaginal trachelectomy (8%, 95% confidence interval 2%-23%), 5 of 37 after simple vaginal trachelectomy (14%, 95% confidence interval 5%-29%), and 5 of 54 after conization (9%, 95% confidence interval 3%-20%), with no statistically significant difference between groups (p = .62).
CONCLUSION: Cervical hemorrhage was the most common severe post-operative complication across all 3 surgical approaches, typically occurring within the first 48 hours after surgery. This finding highlights the importance of careful perioperative hemostatic management and pre-operative counseling in fertility-sparing cervical surgery.