Long term complications after radical hysterectomy with pelvic lymphadenectomy

To evaluate the incidence of long-term complications in stage IB and IIA cervical cancer patients undergoing radical hysterectomy with bilateral pelvic lymphadenectomy.

A retrospective review on 290 patients who were treated with primary type III radical hysterectomy with bilateral pelvic lymphadenectomy between January 1, 1997 and December 31, 2005. Long-term complications were classified in two categories, voiding dysfunction and complication from lymphadenectomy such as lymphocyst and lymphedema.

Forty-two patients (14.5%) required urethral catheterization more than four weeks. Only four patients (1.4%) were diagnosed as neurogenic bladder and required permanent self-catheterization. Two hundred forty eight patients (85.5%) returned to normal voiding within 1 month postoperatively. The incidence of lymphocyst was 9.3%; however, almost of them were asymptomatic and resolved spontaneously within a few months. Only four patients (1.4%) had complicated lymphocyst and required hospitalization with intravenous antibiotic and drainage procedure. Six patients (2.1%) were diagnosed as lymphedema after exclusion of deep vein thrombosis and recurrent cervical carcinoma. Pelvic lymph node metastasis and postoperative adjuvant radiation were not significant risk factors for lymphocyst and lymphedema.

Radical hysterectomy with lymphadenectomy is the treatment of choice in stage IB and IIA cervical cancer with excellent survival rate. However there are long-term complications such as voiding dysfunction, lymphocyst, and lymphedema. Although these complications are not life threatening, they can affect the quality of life.