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Long-Term Oncological Outcome After Conventional Radical Hysterectomy Versus 2 Nerve-Sparing Modalities for Early Stage Cervical Cancer
  1. Mignon Dingena Johanna Maria van Gent, MD*,
  2. Mandy Rademaker, MD*,
  3. Johanna Cornelia Bernadette van der Veer, MD*,
  4. Mariëtte Inie Elizabeth van Poelgeest, MD, PhD*,
  5. Katja Nicoline Gaarenstroom, MD, PhD*,
  6. Hein Putter, MD, PhD,
  7. Johannes Baptist Maria Zacharias Trimbos, MD, PhD* and
  8. Cor Doede de Kroon, MD, PhD*
  1. *Departments of Gynaecology,
  2. Departments of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.
  1. Address correspondence and reprint requests to Mignon Dingena Johanna Maria van Gent, MD, Department of Gynaecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. E-mail:;


Objectives Nerve-sparing radical hysterectomy for early stage cervical cancer was introduced to improve quality of life after treatment. Sparing the pelvic autonomic nerves reduces bladder, bowel, and sexual dysfunction. The Leiden nerve-sparing radical hysterectomy (LNSRH) was modified to the Swift procedure, the latter being more radical regarding the sacrouterine and parametrial resection. We investigate whether nerve-sparing surgery has comparable oncological outcomes as the conventional radical hysterectomy (CRH). Concurrently, we investigate whether there is a difference regarding the oncological outcomes of the 2 nerve-sparing techniques.

Methods This is a single-center, observational prospective cohort study analyzing oncological outcomes in women undergoing CRH (1994–1999), LNSRH (2001–2005), or Swift procedure (2006–2010) for early stage cervical cancer (International Federation of Gynecology and Obstetrics IA2–IIA).

Results Three hundred sixty-three patients (124 CRH, 122 LNSRH, and 117 Swift) were included. International Federation of Gynecology and Obstetrics stage IB2 or higher (P = 0.005) was significantly more prevalent in the CRH cohort. The 5-year pelvic relapse–free survival and overall survival were not significantly different between the 3 cohorts (P = 0.116). Regarding the nerve-sparing cohorts, the Swift cohort showed a significant better 5-year overall survival (87.2%) compared with the LNSRH cohort (78.8%) (P = 0.04). In the LNSRH cohort, resection planes less than 5 mm free and need for adjuvant therapy were significantly higher than in the Swift cohort (P = 0.026 and 0.046, respectively).

Conclusions The nerve-sparing radical hysterectomy shows a similar oncological outcome compared with the CRH. The more radical Swift version of nerve-sparing techniques is preferable to the former LNSRH procedure.

  • Nerve-sparing
  • Cervical cancer
  • Radical hysterectomy
  • Survival
  • Swift

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  • The authors declare no conflicts of interest.

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