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Simple versus Radical Hysterectomy in Women with Low-Risk Cervical Cancer
Marie Plante1, Janice S Kwon1, Sarah Ferguson1
1From Centre Hospitalier Universitaire de Québec, Quebec (M.P.), the University of British Columbia, Vancouver (J.S.K., L.B.), Princess Margaret Hospital, Toronto (S.F.), Centre Hospitalier de l'Université de Montréal, Montreal (V.S.), and the Canadian Cancer Trials Group, Queen's University, Kingston, ON (D.T., L.E.S.) - all in Canada; Institut Claudius Regaud, IUCT-Oncopole, Toulouse (G.F.), and Gustave Roussy Cancer Center, Villejuif (A.M.) - both in France; Leiden University Medical Center, Leiden (C.K.), and the Netherlands Cancer Institute, Amsterdam (W.V.D.) - both in the Netherlands; Royal Hallamshire Hospital, Sheffield (J.T.), and Nottingham University Hospitals, Nottingham (K.W.) - both in the United Kingdom; LMU University Hospital, Munich (S.M.), and University of Tübingen Hospital, Tübingen (S.K.) - both in Germany; Centre Hospitalier Universitaire de Liege, Liege, Belgium (F.G.); Medical University of Graz, Graz, Austria (K.T.); Oslo University Hospital, Oslo (B.E.); Seoul National University College of Medicine, Seoul, South Korea (J.-W.K.); and St. James' Hospital, Dublin (N.G.).
For early-stage cervical cancer, simple hysterectomy is as effective as radical hysterectomy in preventing pelvic recurrence. This less invasive procedure also significantly reduces the risk of urinary incontinence and retention.
Area of Science:
- Gynecologic Oncology
- Surgical Oncology
- Clinical Trials
Background:
- Retrospective studies indicate low parametrial infiltration in early-stage, low-risk cervical cancer, questioning the necessity of radical hysterectomy.
- Large randomized trials comparing radical and simple hysterectomy outcomes are lacking.
Purpose of the Study:
- To compare the efficacy and safety of radical hysterectomy versus simple hysterectomy in patients with low-risk cervical cancer.
- To determine if simple hysterectomy is non-inferior to radical hysterectomy in preventing pelvic recurrence.
Main Methods:
- A multicenter, randomized, noninferiority trial involving 700 patients with low-risk cervical cancer (≤2 cm lesions, limited stromal invasion).
- Comparison of radical hysterectomy versus simple hysterectomy with lymph-node assessment.
- Primary outcome: pelvic recurrence at 3 years, with a noninferiority margin of 4 percentage points.
Main Results:
- Pelvic recurrence at 3 years was 2.17% with radical hysterectomy and 2.52% with simple hysterectomy (absolute difference: 0.35 percentage points).
- Simple hysterectomy was not inferior to radical hysterectomy regarding pelvic recurrence.
- Lower incidence of urinary incontinence and retention observed in the simple hysterectomy group post-surgery.
Conclusions:
- Simple hysterectomy is a viable alternative to radical hysterectomy for low-risk cervical cancer, offering comparable oncologic outcomes.
- Simple hysterectomy demonstrates a significant reduction in postoperative urinary dysfunction compared to radical hysterectomy.
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