Cervical cancer, which develops in the lower portion of the uterus, known as the cervix, typically grows slowly. Cells in the cervix can change, a process known as dysplasia, and the resulting abnormal cells, if not removed, can develop into cervical cancer.
When cervical cancer occurs, treatment options vary based on many factors, including how far the disease has advanced and the overall health of the patient. Some cervical cancer patients may undergo a simple hysterectomy (also known as a complete or total hysterectomy). A simple hysterectomy removes the uterus and cervix.
The perimetrium, fat and connective tissue around the uterus, connects the uterus to the cervix and other tissues. Some patients with cervical cancer experience “parametrial invasion” (also referred to as parametrial infiltration), during which cervical cancer has spread into the parametrial tissue.
Because of this risk of parametrial invasion, many cervical cancer patients opt for a different procedure called a radical hysterotomy. During a radical hysterectomy, a surgeon removes the uterus, cervix, part of the vagina, and various connective tissues, ligaments, and fat around the cervix.
Some research suggests that women with early-stage cervical cancer undergoing radical hysterectomy achieve no long-term survival benefit compared to those receiving a simple hysterectomy. Further, many studies indicate a low risk of parametrial invasion in patients diagnosed with early-stage cervical cancer. Taken together, these findings raise questions about the utility of the more complex radical hysterectomy for women with early-stage disease.
This question led to a study recently published in the New England Journal of Medicine where researchers compared outcomes between women undergoing radical and simple hysterectomies. The multicenter study (NCT01658930) randomized 700 patients, most of whom had stage 1B cervical cancer, to undergo either a radical or simple hysterectomy.
Three years after surgery, the recurrence rates remained remarkably low and almost identical (2.17% versus 2.52% in the radical versus simple hysterectomy groups).
The researchers also evaluated differences in the onset of urinary complications that can negatively impact the quality of life of cancer survivors. Initially, within four weeks of surgery, urinary incontinence occurred in 2.4% of the simple hysterectomy group and 5.5% of the radical hysterectomy group. In the long term (past four weeks after surgery), the difference in urinary incontinence expanded, occurring in 4.7% of those who had a simple hysterectomy and 11% in the radical hysterectomy group. Urinary retention, which can lead to inflammation or infection, also occurred less frequently in the simple hysterectomy group (0.6% versus 11% initially and 0.6% versus 9.9% long-term).
The authors conclude that simple hysterectomy did not confer a worse outcome than radical hysterectomy in a large cohort of women with early-stage cervical cancer. The added benefit of reduced risk of short- and long-term complications also provides a rationale for considering simple hysterectomy for certain cervical cancer patients.
Sources: Ann Med Surg, Cancer Manag Res, Obstet Gynecol, NEJM