The 65-year-old’s greatest hits show was pushed back from its original July start date after she was hospitalized in intensive care for a serious bacterial infection.

“I’m really damn surprised I made it this far. And I mean that on so many levels,” she told fans at the O2 arena.

Wearing the corset and chains that defined her breakthrough, she sang “Into The Groove” before a sound problem forced her to ad-lib about her early struggles in New York.

With the backing track restored, 1983’s “Holiday” recreated the hedonistic joy of a New York club before the onslaught of AIDS, marked by a tribute to those who had died.

The mix of religious imagery and sexuality that elevated Madonna from pop star to cultural icon was the backdrop to “Like a Prayer”, while “Vogue”, the hit that powered her into the 1990s, saw one of the stages become a catwalk.

Madonna addressed the situation in the Middle East. “There’s a lot of really crazy things happening in the world that are so, so painful to witness,” she said. “But even though our hearts are broken, our spirits cannot be broken.”

On her health scare, she said: “It was a crazy year for me as well. And I didn’t think I was going to make it.”

With more than 40 songs in the show, some like “Papa Don’t Preach” were dispatched in seconds, but all of her re-inventions, from Catholic Madonna to Country Madonna, featured.

The seven-time Grammy Award winner has rescheduled the tour’s North American leg to start in December after her European concerts.