Less invasive hysterectomy an option for some cervical cancer patients, study says

Some women with early-stage cervical cancer can be safely treated with a less invasive hysterectomy that has fewer complications, a new Canadian study says.

The current standard treatment is a radical hysterectomy, removing not only the uterus and cervix, but also surrounding tissues and up to one-third of the vagina, said senior author Dr. Lois Shepherd, a professor of pathology and molecular medicine at Queen's University in Kingston, Ont.

But the researchers found that women who had a "simple" hysterectomy —where surrounding tissues and most of the vagina were left intact — were at no higher risk of cancer recurring in the pelvic area after three years than those who had a radical hysterectomy.

"(The study has) established an option for women with early-stage, low-risk cervical cancer that's a lot less intrusive or invasive, with fewer side-effects," said Shepherd in an interview on Wednesday.

Women who had a radical hysterectomy were more likely to have urinary incontinence and sexual side-effects after surgery, said the study published in the New England Journal of Medicine.

The simple hysterectomy should only be an option for cervical cancer patients who meet strict criteria, said lead author Dr. Marie Plante, a gynecologic oncologist at CHU de Quebec at Laval University.

The cancer must be at an early stage, with superficial lesions less than or equal to two centimetres. In addition, the lymph nodes must be free of cancer, Plante said.

"There's been a gradual sort of a trend whereby physicians have started to suggest less radical surgery based on retrospective data, if you will, that was accumulating suggesting that a simple hysterectomy might be fine (for those patients)," she said

But their study, which is a randomized Phase 3 clinical trial, provides much more definitive evidence that the less invasive surgery is safe, Plante said.

Dr. Brent Jim, a gynecologic oncologist in Regina who was not involved in the study, said the new research is "practice changing."

The availability of cervical cancer screening programs in Canada means a significant number of women are diagnosed in early stages and could then be eligible for the simple hysterectomy option, he said.

The study included 700 women from 12 different countries who had early-stage cervical cancer. More than a quarter of the participants were recruited in Canada.

This report by The Canadian Press was first published Feb. 28, 2024.

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