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Radical hysterectomy in early cervical cancer in Europe: characteristics, outcomes and evaluation of ESGO quality indicators
  1. Felix Boria1,
  2. Luis Chiva2,
  3. Vanna Zanagnolo3,
  4. Denis Querleu4,
  5. Nerea Martin-Calvo5,
  6. Mihai Emil Căpîlna6,
  7. Anna Fagotti7,
  8. Ali Kucukmetin8,
  9. Constantijne Mom9,
  10. Galina Chakalova,10,
  11. Aliyev Shamistan11,
  12. Mario Malzoni12,
  13. Fabrice Narducci13,
  14. Octavio Arencibia14,
  15. Francesco Raspagliesi15,
  16. Tayfun Toptas16,
  17. David Cibula17,
  18. Dilyara Kaidarova18,
  19. Mehmet Mutlu Meydanli19,
  20. Mariana Tavares20,
  21. Dmytro Golub21,
  22. Anna Myriam Perrone22,
  23. Robert Poka23,
  24. Dimitrios Tsolakidis24,
  25. Goran Vujić25,
  26. Marcin A Jedryka26,
  27. Petra L M Zusterzeel27,
  28. Jogchum Jan Beltman28,
  29. Frederic Goffin29,
  30. Dimitrios Haidopoulos30,
  31. Herman Haller31,
  32. Robert Jach32,
  33. Iryna Yezhova33,
  34. Igor Berlev34,
  35. Margarida Bernardino35,
  36. Rasiah Bharathan36,
  37. Maximilian Lanner37,
  38. Minna M Maenpaa38,
  39. Vladyslav Sukhin39,40,
  40. Jean-Guillaume Feron41,
  41. Robert Fruscio42,43,
  42. Kersti Kukk44,
  43. Jordi Ponce45,
  44. María Alonso-Espías46,
  45. Jose Angel Minguez47,
  46. Daniel Vázquez-Vicente48,
  47. Nabil Manzour49,
  48. Matias Jurado47,
  49. Teresa Castellanos48,
  50. Enrique Chacon50 and
  51. Juan Luis Alcazar51
  1. 1Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Madrid, Spain
  2. 2Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
  3. 3Istituto Europeo di Oncologia, Milano, Anognnn, Italy
  4. 4Department of Surgery, Institut Bergonie, Bordeaux, France
  5. 5Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
  6. 6Emergency County Hospital Targu-Mures, Targu Mures, Romania
  7. 7Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
  8. 8Queen Elizabeth Hospital, Gateshead, Gateshead, UK
  9. 9Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
  10. 10University Oncologic Hospital, Sofia, Bulgaria
  11. 11National Center of Oncology, Baku, Azerbaijan
  12. 12Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
  13. 13Department of Gynecology, Centre Oscar Lambret, Lille, France
  14. 14University Maternal Hospital Canary Islands, Las Palma, Spain
  15. 15Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
  16. 16Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
  17. 17Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
  18. 18Oncogynecology, Kazahskij Naucno-Issledovatel'skij Institut Onkologii i Radiologii, Almaty, Kazakhstan
  19. 19Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
  20. 20Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
  21. 21Department of Surgery, LISOD - Israeli Oncological Hospital, Kyiv region, Ukraine
  22. 22Azienda Ospedaliero-Universitaria di Bologna Policlinico SantOrsola-Malpighi, Bologna, Italy
  23. 23Obstetrics and Gynecology, Unit of Gynecologic Oncology, Institute of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
  24. 24General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Central Macedonia, Greece
  25. 25Clinical Hospital Center, Zagreb, Croatia
  26. 26Department of Oncological Gynecology, Uniwersytet Medyczny im Piastów Śląskich we Wrocławiu (Wroclaw Medical University), Wroclaw, Poland
  27. 27Department of Gynecological Oncology, Radboudumc, Nijmegen, Netherlands
  28. 28Department of Gynaecology, LUMC, Leiden, Netherlands
  29. 29Department of Obstetrics and Gynecology, University of Liege, Liege, Belgium
  30. 30Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
  31. 31Clinical Hospital Center Rijeka, Rijeka, Croatia
  32. 32Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
  33. 33Lviv Oncology Center, Lviv, Ukraine
  34. 34North-Western State Medical University. N.N. Petrov Research Institute of Oncology, Saint-Petersburg, Saint-Petersburg, Russian Federation
  35. 35Department of Gynecology, Instituto Português de Oncologia de Lisboa, Lisboa, Lisboa, Portugal
  36. 36University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
  37. 37Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Steiermark, Austria
  38. 38Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
  39. 39Department of Oncology, Radiology and Radiation Medicine, V N Karazin Kharkiv National University, Harkiv, Ukraine
  40. 40Department of Oncogynecology, Grigoriev Institute for Medical Radiology NAMS of Ukraine, Harkiv, Ukraine
  41. 41Institut Curie, Paris, Île-de-France, France
  42. 42Department of Medicine and Surgery, University of Milan–Bicocca, Milano, Italy
  43. 43Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
  44. 44North Estonia Medical Centre, Tallinn, Estonia
  45. 45Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
  46. 46Department of Gynecologíc Oncology, Hospital Universitario La Paz, Madrid, Madrid, Spain
  47. 47Department of Gynecology, Clinica Universitaria de Navarra, Pamplona, Navarra, Spain
  48. 48Department of Gynecology, Clinica Universitaria de Navarra, Madrid, Spain
  49. 49Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Pamplona, Navarra, Spain
  50. 50Department of Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
  51. 51Department of Obstetrics and Gynecology, School of Medicine; University of Navarra, Pamplona, Spain
  1. Correspondence to Dr Luis Chiva, Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain; lchiva{at}


Introduction Comprehensive updated information on cervical cancer surgical treatment in Europe is scarce.

Objective To evaluate baseline characteristics of women with early cervical cancer and to analyze the outcomes of the ESGO quality indicators after radical hysterectomy in the SUCCOR database.

Methods The SUCCOR database consisted of 1272 patients who underwent radical hysterectomy for stage IB1 cervical cancer (FIGO 2009) between January 2013 and December 2014. After exclusion criteria, the final sample included 1156 patients. This study first described the clinical, surgical, pathological, and follow-up variables of this population and then analyzed the outcomes (disease-free survival and overall survival) after radical hysterectomy. Surgical-related ESGO quality indicators were assessed and the accomplishment of the stated recommendations was verified.

Results The mean age of the patients was 47.1 years (SD 10.8), with a mean body mass index of 25.4 kg/m2 (SD 4.9). A total of 423 (36.6%) patients had a previous cone biopsy. Tumor size (clinical examination) <2 cm was observed in 667 (57.7%) patients. The most frequent histology type was squamous carcinoma (794 (68.7%) patients), and positive lymph nodes were found in 143 (12.4%) patients. A total of 633 (54.8%) patients were operated by open abdominal surgery. Intra-operative complications occurred in 108 (9.3%) patients, and post-operative complications during the first month occurred in 249 (21.5%) patients, with bladder dysfunction as the most frequent event (119 (10.3%) patients). Clavien-Dindo grade III or higher complication occurred in 56 (4.8%) patients. A total of 510 (44.1%) patients received adjuvant therapy. After a median follow-up of 58 months (range 0–84), the 5-year disease-free survival was 88.3%, and the overall survival was 94.9%. In our population, 10 of the 11 surgical-related quality indicators currently recommended by ESGO were fully fulfilled 5 years before its implementation.

Conclusions In this European cohort, the rate of adjuvant therapy after radical hysterectomy is higher than for most similar patients reported in the literature. The majority of centers were already following the European recommendations even 5 years prior to the ESGO quality indicator implementations.

  • cervical cancer
  • postoperative complications
  • radiation
  • SLN and lympadenectomy
  • hysterectomy

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Data will be available upon the requirement of the reviewers at any time.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Data will be available upon the requirement of the reviewers at any time.

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  • Collaborators On behalf of the SUCCOR study Group: Nabil Abdalla, Özgür Akbayir, Sedat Akgöl, Elif Aksahin, Shamistan Aliyev, Maria Alonso-Espias, Igor Aluloski, Claudia Andrade, Nikola Badzakov, Rosa Barrachina, Giorgio Bogani, Eduard-Aexandru Bonci, Hélène Bonsang-Kitzis, Cosima Brucker, Laura Cárdenas, Andrea Casajuana, Pere Cavalle, Jorge Cea, Benito Chiofalo, Gloria Cordeiro, Pluvio Coronado, Maria Cuadra, Javier Díez, Teresa Diniz da Costa, Santiago Domingo, Lukas Dostalek, Fuat Demirkiran, Diego Erasun, Mathias Fehr, Sergi Fernandez-Gonzalez, Annamaria Ferrero, Soledad Fidalgo, Gabriel Fiol, Khadra Galaal, José García, Gerhard Gebauer, Fabio Ghezzi,Juan Gilabert, Nana Gomes, Elisabete Gonçalves, Virginia Gonzalez, Frederic Grandjean, Miriam Guijarro, Frédéric Guyon, Jolien Haesen, Gines Hernandez- Cortes, Sofía Herrero, Imre Pete, Ioannis Kalogiannidis, Erbil Karaman, Andreas Kavallaris, Lukasz Klasa, Ioannis Kotsopoulos, Stefan Kovachev, Meelis Leht, Arantxa Lekuona, Mathieu Luyckx, Michael Mallmann, Gemma Mancebo, Aljosa Mandic, Tiermes Marina, Victor Martin, María Belén Martín- Salamanca, Alejandra Martinez, Gesine Meili, Gustavo Mendinhos, Liliana Mereu, Milena Mitrovic, Sara Morales, Enrique Moratalla, Bibiana Morillas, Eva Myriokefalitaki, Maja PakižImre, Stamatios Petousis, Laurentiu Pirtea, Natalia Povolotskaya, Sonia Prader, Alfonso Quesada, Mikuláš Redecha, Fernando Roldan, Philip Rolland, Reeli Saaron, Cosmin-Paul Sarac, Jens-Peter Scharf, Špela Smrkolj, Rita Sousa, Artem Stepanyan, Vladimír Študent, Carmen Tauste, Hans Trum, Taner Turan, Manuela Undurraga, Arno Uppin, Alicia Vázquez, Ignace Vergote, George Vorgias, and Ignacio Zapardiel.

  • Contributors All authors contributed meaningfully to the conception or design of the work or the acquisition, analysis, or interpretation of data for the study. The authors confirm the completeness and accuracy of the data and analyses,the fidelity of the study to the protocol, and the final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.