Quality of life in cervical cancer survivors after nerve-sparing radical hysterectomy, conventional radical hysterectomy or concurrent chemoradiotherapy

Abstract

Background: Cervical cancer treatments, including radical hysterectomy and chemoradiotherapy, often lead to urinary, anorectal, and sexual dysfunctions. Nerve-sparing radical hysterectomy (NSRH) aims to reduce such complications, but evidence on long-term quality of life (QoL) remains limited. Objective: To compare QoL outcomes in cervical cancer survivors after NSRH, conventional radical hysterectomy (CRH), or concurrent chemoradiotherapy (CCR). Methods: A cross-sectional study enrolled 427 patients (241 NSRH, 60 CRH, 126 CCR) aged ≤60 years with ≥6 months post-treatment follow-up. QoL was assessed using EORTC QLQ-C30/CX24, Female Sexual Function Index (FSFI), and a self-reported questionnaire. Statistical analyses included ANOVA and chi-square tests. Results: Urinary symptoms occurred in 27.4% (NSRH), 40.0% (CRH), and 18.6% (CCR) (*p*=0.004). Anorectal symptoms were reported in 23.2% (NSRH), 25.0% (CRH), and 18.6% (CCR) (*p*=0.360). Among sexually active patients, FSFI total scores were higher in NSRH (23.8) vs. CRH (23.3) and CCR (21.6) (*p*=0.026). NSRH also showed superior sexual desire, arousal, and orgasm scores. QoL scores (EORTC QLQ-C30/CX24) indicated better outcomes in constipation (*p*=0.003), lymphedema (*p*<0.001), and sexual activity (*p*=0.027) for NSRH. Subgroup analysis confirmed NSRH alone had fewer complications than NSRH with adjuvant radiation. Conclusion: NSRH demonstrates significant advantages in preserving urinary, anorectal, and sexual functions, thereby improving QoL compared to CRH or CCR. It is a preferable option for early-stage cervical cancer, particularly in younger patients.