Early post-operative complications after fertility-sparing surgery for cervical carcinoma: a retrospective study of a centralized national cohort of 127 consecutive women.

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.