June 15, 2023 – An easy hysterectomy is a protected and effective treatment option for girls with early-stage, low-risk cervical cancer, in response to a brand new study.
Compared to the more complex radical hysterectomy, the outcomes by way of cancer freedom were similar and girls reported a greater quality of life.
These results come from a big, international Phase III clinical trial presented on the 2023 Annual Meeting of the American Society of Clinical Oncology (ASCO).
An easy hysterectomy involves removing the uterus and cervix. A radical hysterectomy, alternatively, is a more extensive procedure that typically involves removing not only the uterus and cervix, but in addition the lymph nodes, the upper a part of the vagina and the tissue across the cervix.
The current standard of take care of women with early-stage, low-risk cervical cancer is radical hysterectomy. However, although the possibilities of cure are high, the surgery can have significant uncomfortable side effects.
“Although radical surgery is very effective in treating low-risk disease, women are at risk of survival problems due to long-term side effects of surgery, including impairment of bladder, bowel and sexual function,” said study creator Marie Plante, MD, professor within the Department of Obstetrics and Gynecology at Université Laval in Quebec, who presented the outcomes on the meeting.
Because of the high risk of complications, doctors have wondered if a less complicated surgery could achieve the identical results but with fewer uncomfortable side effects. Plante explained that some studies have already shown that this will likely be possible in a low-risk population. “A less radical surgery could be a safe option that is associated with less morbidity, which is what we call surgical de-escalation,” she said.
In this study, Plante and her team randomly assigned 700 women to either a radical or a straightforward hysterectomy. Both groups had lymph node removal from the pelvis to see if the cancer had spread. The researchers then followed the groups for 3 years.
The researchers compared the speed of reoccurrence (or reoccurrence) of the pelvic cancer between the 2 groups. Three years after surgery, they found that the pelvic reoccurrence rate was similar in each groups. The cancer recurred in 2.5% of girls who had a straightforward hysterectomy, compared with 2.2% of girls who had a radical hysterectomy. Overall, after about 4.5 years, the cancer recurred in 11 women in the straightforward hysterectomy group and 10 in the novel hysterectomy group.
Survival rates were also similar in each groups. The percentage of girls alive 3 years after surgery was 99.1% in the straightforward hysterectomy group and 99.4% in the novel hysterectomy group.
Importantly, women who underwent a straightforward hysterectomy had fewer complications during surgery and fewer immediate and long-term bladder problems. Sexual function was also higher in the straightforward hysterectomy group, and these women reported less pain and an overall higher quality of life.
“After an appropriate and thorough preoperative evaluation – and this is key – simple hysterectomy can now be considered the new standard of care for patients with early-stage, low-risk cervical cancer,” Plante said.
Bhavana Pothuri, MD, a gynecologic oncologist at New York University's Langone Perlmutter Cancer Center, said this study may be very exciting since it “illustrates ways to minimize treatments while maintaining the effectiveness of our cancer treatments.”
“The overall evidence is that less radical surgery is safe and effective in this group of early cervical cancers,” said Pothuri, who was not involved within the study.