Profile of treatment-related complications in women with clinical stage IB-IIB cervical cancer: A nationwide cohort study in Japan

PLoS One. 2019 Jan 7;14(1):e0210125. doi: 10.1371/journal.pone.0210125. eCollection 2019.


Objective: To examine clinico-pathological factors associated with surgical complications and postoperative therapy for clinical stage IB-IIB cervical cancer.

Methods: This nationwide multicenter retrospective study examined women with clinical stage IB-IIB cervical cancer who underwent radical hysterectomy plus pelvic and/or para-aortic lymphadenectomy between 2008-2009 at 87 institutions of the Japanese Gynecologic Oncology Group (n = 693). Multivariate models were used to identify independent predictors of perioperative grade 3-4 complications and bladder dysfunction.

Results: The overall intraoperative and postoperative complication rates were 3.3% and 9.8%, respectively. Clinical stage was not associated with perioperative complications (P = 0.15). Radiotherapy-based adjuvant therapy was significantly associated with an increased risk of postoperative complications (radiotherapy alone: adjusted-odds ratio [OR] 3.19, 95% confidence interval [CI] 1.46-6.99, P = 0.004; radiotherapy plus chemotherapy: adjusted-OR 3.26, 95%CI 1.66-6.41, P = 0.001), whereas chemotherapy was not (P = 0.45). Nerve-sparing surgery significantly reduced the risk of postoperative bladder dysfunction (adjusted-OR 0.57, 95%CI 0.37-0.90, P = 0.02) whereas adjuvant chemotherapy increased the risk of bladder dysfunction (adjusted-OR 2.06, 95%CI 1.16-3.67, P = 0.01). Among women receiving adjuvant chemotherapy, nerve-sparing radical hysterectomy significantly reduced the risk of bladder dysfunction (15.0% versus 32.9%, OR 0.31, 95%CI 0.14-0.68, P = 0.004). After propensity score matching, survival outcomes were similar with both types of adjuvant therapy (radiotherapy-based versus chemotherapy, P>0.05).

Conclusion: Our study highlighted two distinct complication profiles of adjuvant therapy after radical hysterectomy for clinical stage IB-IIB cervical cancer, with radiotherapy increasing grade 3-4 adverse events and chemotherapy increasing bladder dysfunction. In this setting, nerve-sparing surgery may be useful if chemotherapy is being considered for adjuvant therapy.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Chemoradiotherapy, Adjuvant / adverse effects
  • Chemotherapy, Adjuvant / adverse effects
  • Disease-Free Survival
  • Female
  • Humans
  • Hysterectomy / adverse effects*
  • Incidence
  • Intraoperative Complications / epidemiology*
  • Intraoperative Complications / etiology
  • Japan / epidemiology
  • Lymph Node Excision / adverse effects*
  • Lymphatic Metastasis / pathology
  • Lymphatic Metastasis / prevention & control
  • Middle Aged
  • Neoplasm Staging
  • Perioperative Period / statistics & numerical data*
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Radiotherapy, Adjuvant / adverse effects
  • Retrospective Studies
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / therapy*

Grants and funding

The authors received no specific funding for this work.