Surgical de-escalation of cervical cancer treatment in limited-resource settings

Cervical cancer remains a major public health concern in low- and middle-income countries, where more than 80% of new cases and deaths occur each year. For decades, the gold standard for early-stage disease has been radical hysterectomy or radical trachelectomy with lymph node assessment, procedures associated with significant morbidity. Recent evidence from retrospective and prospective studies demonstrates that less radical surgical approaches, such as conization or simple hysterectomy, can achieve oncologic outcomes comparable to radical procedures in carefully selected patients with early-stage disease while reducing morbidity. In this narrative review, we summarize the available evidence on conservative surgical management of cervical cancer in low- and middle-income countries, highlight its feasibility and oncologic safety, and discuss the unique barriers that hinder the widespread implementation of surgical de-escalation in resource-limited environments.