{"id":46566,"date":"2024-03-27T12:00:00","date_gmt":"2024-03-27T12:00:00","guid":{"rendered":"https:\/\/www.cancer.gov\/news-events\/cancer-currents-blog\/2024\/cervical-cancer-simple-hysterectomy"},"modified":"2024-11-03T15:11:52","modified_gmt":"2024-11-03T15:11:52","slug":"simple-hysterectomy-may-expand-treatment-options-for-early-stage-cervical-cancer","status":"publish","type":"post","link":"https:\/\/ogkologos.com\/en\/simple-hysterectomy-may-expand-treatment-options-for-early-stage-cervical-cancer\/","title":{"rendered":"Simple Hysterectomy May Expand Treatment Options for Early-Stage Cervical Cancer"},"content":{"rendered":"

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For some women with early-stage cervical cancer, a procedure called a simple hysterectomy may be a good treatment option rather than a radical hysterectomy.<\/p>\n

Credit: iStock\/SDI Productions<\/p>\n<\/p><\/div>\n<\/figcaption><\/figure>\n<\/p><\/div>\n

Most people with early-stage cervical cancer are treated with a radical hysterectomy. But doctors have long wondered whether a less extensive surgery could be a safe and effective alternative to the radical procedure.<\/p>\n

According to the results of a large clinical trial<\/a>, the answer seems to be yes. In the trial, 700 people with early-stage cervical cancer underwent either a radical hysterectomy<\/a> or a more limited surgical procedure called a simple hysterectomy<\/a>. <\/p>\n

Three years after surgery, the cancer had come back in the pelvic area among less than 3% of the participants<\/a>, regardless of which procedure they had undergone, researchers reported in the New England Journal of Medicine<\/em> on February 29.<\/p>\n

However, participants who had a simple hysterectomy experienced fewer side effects<\/a>, such as urinary incontinence<\/a> and urinary retention<\/a> (trouble emptying all of the urine from the bladder), than those who had a radical hysterectomy. Measures of quality of life<\/a> appeared to favor the simple over the radical hysterectomy, the researchers found. <\/p>\n

\u201cBoth surgeries have similarly low rates of cancer recurrence<\/a>,\u201d said study leader Marie Plante, M.D., of Universit\u00e9 Laval in Quebec. \u201cBut the less radical surgery was associated with fewer surgical complications and a better quality of life.\u201d<\/p>\n

The study was a noninferiority trial, meaning it was not designed to determine which procedure was better, Dr. Plante noted; rather, the goal was to determine whether a simple hysterectomy was not worse than the radical procedure for preventing a recurrence. <\/p>\n

Pedro Ramirez, M.D., of Houston Methodist Hospital, who wrote an accompanying editorial, predicted that a simple hysterectomy will likely become the new standard treatment<\/a> for people with early-stage, low-risk cervical cancer as defined in the trial. <\/p>\n

The research, Dr. Ramirez explained, is part of an effort by cancer surgeons to de-escalate treatment, by shifting away from radical procedures toward more conservative approaches<\/a> that may have fewer side effects. <\/p>\n

\u201cThis trial so far shows that by de-escalating the treatment, we are not compromising outcomes for patients,\u201d Dr. Ramirez said.<\/p>\n

Complications, side effects, and limitations of the trial<\/h2>\n

During a simple hysterectomy, a surgeon removes the uterus and the cervix. By comparison, a radical hysterectomy involves removing the uterus, cervix, part of the vagina, and ligaments and tissues around the uterus (parametrium<\/a>).<\/p>\n

The radical surgery has long been the recommended treatment for people diagnosed with early-stage cervical cancers considered to be at low risk of the cancer spreading or coming back. Studies have suggested that only about 1% of low-risk, early-stage cervical cancers spread to the tissue near the cervix.<\/p>\n

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In a simple hysterectomy, the uterus and the cervix are removed. A radical hysterectomy is more extensive, removing the uterus, cervix, part of the vagina, and parametrium. <\/p>\n

Credit: \u00a9 Terese Winslow<\/p>\n<\/p><\/div>\n<\/figcaption><\/figure>\n<\/div>\n

\u201cWe have wondered whether it\u2019s necessary to do such a radical surgery for a cancer with such a low probability of spread to the surrounding tissues,\u201d said Dr. Plante. Such questions were the basis for developing the SHAPE trial. <\/p>\n

The Canadian Cancer Trials Group led the study, which was funded by the Canadian Institutes of Health Research and Canadian Cancer Society, in collaboration with the Gynecologic Cancer Intergroup. <\/p>\n

Almost identical recurrence rates with simple hysterectomy<\/h2>\n

All participants in the trial had early-stage cervical cancer that met certain low-risk criteria (see box). All participants had surgery to remove lymph nodes<\/a> in the pelvis (lymph node dissection<\/a>) and then were randomly assigned to get a simple or radical hysterectomy.  <\/p>\n