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Radical Hysterectomy for Cervical Cancer: the Right Surgical Approach

  • Gynecologic Cancers (LA Cantrell, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Radical hysterectomy with pelvic lymph node assessment is the standard initial therapy for early-stage cervical cancer. Radical hysterectomy via laparotomy (an “open” approach) was first described more than 100 years ago and has been the standard for decades. Minimally invasive surgery (MIS) has been increasingly adopted by many surgeons due to its reported perioperative benefits. MIS was deemed safe for radical hysterectomy for many years based on multiple retrospective publications. Recently, the Laparoscopic Approach to Cervical Cancer (LACC) trial reported that patients randomized to MIS had inferior oncologic outcomes. The results of the LACC trial and subsequent retrospective studies led multiple professional societies to state that open radical hysterectomy should remain the gold standard surgical approach. We acknowledge that the open approach for radical hysterectomy is an appropriate option for all cervical cancer patients eligible for surgical treatment. However, considering the limitations of the LACC trial and the available data from other retrospective studies, we feel the MIS approach should not be simply abandoned. There may still be a role for MIS in cervical cancer surgery for properly and carefully selected cases and with detailed counseling; surgeons should analyze their own outcomes closely in order to perform such counseling. Modification of surgical technique and maintaining proper oncologic surgical principles are key for MIS to remain a viable option. Tumor manipulation and contamination should be avoided. Transcervical uterine manipulators should not be used. Cervical and tumor containment prior to colpotomy, as is performed during an open approach, is required. This will all require validation in future trials. We await the results of ongoing randomized trials to further inform us. A one-size-fits-all approach may be short-sighted; we may need to decide treatment strategy based on the notion of the right surgical approach for the right patient by the right surgeon.

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  1. Benny Brandt and Gabriel Levin contributed equally to this work.

Authors and Affiliations

  1. Department of Gynecologic Oncology, Sheba Medical Center, Ramat Gan, Israel

    Benny Brandt MD

  2. Department of Gynecologic Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Gabriel Levin MD

  3. Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Gabriel Levin MD

  4. Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Mario M. Leitao Jr MD

  5. Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA

    Mario M. Leitao Jr MD

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Correspondence to Mario M. Leitao Jr MD.

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Benny Brandt declares that he has no conflict of interest. Gabriel Levin declares that he has no conflict of interest. Mario M. Leitao, Jr. has received compensation for participation on an advisory board from Johnson & Johnson/Ethicon, and is also an ad hoc speaker for Intuitive Surgical, Inc.

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Brandt, B., Levin, G. & Leitao, M.M. Radical Hysterectomy for Cervical Cancer: the Right Surgical Approach. Curr. Treat. Options in Oncol. 23, 1–14 (2022). https://doi.org/10.1007/s11864-021-00919-z

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