Is Simple Hysterectomy Noninferior to Radical Hysterectomy in Low-Risk Cervical Cancer?

Radical hysterectomy is the standard of care for women with a diagnosis of early-stage cervical cancer, but this surgery is known to a have higher risk of perioperative complications than a more-conservative surgical procedure. In an international trial, investigators assessed whether simple hysterectomy is noninferior to radical hysterectomy in patients with early-stage cervical cancer and low-risk features.

Eligibility criteria included squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma histologies of any grade; FIGO stage IA2 or IB1 (lesion ≤2 cm); limited stromal invasion; and no evidence of lymph node involvement on preoperative imaging. A total of 700 patients were randomized to either radical hysterectomy or simple hysterectomy; however, the surgical approach (open vs. minimally invasive) was at the discretion of the trial surgeons and was not a stratification factor. Most patients (92%) had stage IB1 disease.

The incidence of pelvic recurrence at 3 years (the primary outcome) was 2.52% in the simple hysterectomy arm and 2.17% in the radical hysterectomy arm. Simple hysterectomy was not inferior to radical hysterectomy. Simple hysterectomy was also associated with significantly lower rates of urinary retention and incontinence.