The New England Journal of MedicineSimple versus Radical Hysterectomy in Women with Low-Risk Cervical Cancer

Simplifying Surgical Approaches in Low-Risk Cervical Cancer: A Comparative Study

A recent multicenter, randomized, noninferiority trial provides new insights into the surgical management of low-risk cervical cancer. The study compares the outcomes of radical hysterectomy with simple hysterectomy, focusing on cancer recurrence rates and postoperative complications, offering valuable data for physicians in making informed surgical decisions.

Study Design:

• Type of study: Multicenter, randomized, noninferiority trial.
• Participants: 700 patients with low-risk cervical cancer (tumors ≤2 cm with limited stromal invasion).
• Comparison: Radical hysterectomy vs. simple hysterectomy, including lymph-node assessment.
• Primary Outcome: Pelvic recurrence of cancer at 3 years.
• Noninferiority Margin: 4 percentage points for the difference in pelvic recurrence at 3 years.

Key Findings:

• Pelvic recurrence at 3 years: 2.17% in the radical hysterectomy group vs. 2.52% in the simple hysterectomy group.
• Incidence of urinary incontinence was significantly lower in the simple hysterectomy group both within 4 weeks after surgery (2.4% vs. 5.5%) and beyond 4 weeks (4.7% vs. 11.0%).
• Urinary retention was also significantly lower in the simple hysterectomy group within 4 weeks (0.6% vs. 11.0%) and beyond 4 weeks (0.6% vs. 9.9%).
• The study suggests that simple hysterectomy is not inferior to radical hysterectomy concerning pelvic recurrence at 3 years and is associated with fewer urinary complications.

According to the World Health Organization, cervical cancer is the fourth most common cancer among women globally, with an estimated 604,000 new cases and 342,000 deaths in 2020.

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