Women undergoing minimally invasive radical hysterectomy for early-stage cervical cancer have lower rates of disease-free survival and overall survival compared with those who have open abdominal radical hysterectomy, studies with 4 years of follow-up have found.   A commentary on the two studies described the findings as "a great blow" to minimally invasive surgery for cervical cancer.  Updated guidelines from the US National Comprehensive Cancer Network state that these new findings of worse outcomes from minimally invasive techniques compared with open laparotomy should prompt clinicians to counsel women carefully about the risks and benefits of the different surgical approaches. 
In the randomized non-inferiority LACC (Laparoscopic Approach to Cervical Cancer) trial of 631 patients with FIGO stage IA1 to IB1 disease (92% had stage IB1 disease), disease-free survival at 4.5 years was 86.0% in the minimally invasive surgery group versus 96.5% in the open surgery group (-10.6% difference; 95% CI -16.4 to -4.7).  Minimally invasive surgery was associated with significantly lower overall survival (3-year rate, 93.8% vs. 99.0%). The trial closed early due to the higher rate of recurrence and death in the minimally invasive surgery group.
The second study (a retrospective cohort study) of nearly 2500 US women with stage IA2 or IB1 disease reported a 4-year mortality rate of 9.1% in the minimally invasive surgery group and 5.3% in the open surgery group (hazard ratio: 1.65; 95% CI 1.22 to 2.22). 
Open surgery is the standard approach for radical hysterectomy.  However, use of minimally invasive surgery (laparoscopic or robotic) has been increasing,  supported by evidence from observational studies with short follow-up time showing similar survival rates and reduced morbidity versus open surgery.  See Management: approach See Management: treatment algorithm
A human papillomavirus (HPV)-related malignancy, preventable by HPV vaccination, screening, and treatment of high-grade dysplasia.
Cervical cancer screening by cervical cytology (Pap testing) may detect preinvasive disease. HPV testing can also be used for screening, but is not recommended in women under 30 years of age.
Locally advanced disease may present with bleeding, discharge, pain, or obstructive uropathy.
Staging using International Federation of Gynecology and Obstetrics criteria is based on clinical assessment only. When available, advanced imaging modalities (MRI, PET, PET/CT, CT) are used to evaluate the local extent of disease and to screen for metastases, which may guide treatment planning.
For microinvasive disease, treatment with conization is recommended.
For early stage invasive disease, surgery is recommended.
For locally advanced disease, chemoradiation therapy is significantly superior to radiation therapy alone.
Cervical cancer is a human papillomavirus-related malignancy of the uterine cervical mucosa.
Medical Gynecologic Oncology
Division of Hematology Oncology
Massachusetts General Hospital
RTP is a paid participant in scientific advisory boards for Genentech/Roche. RTP is an author of a number of references cited in this topic.
Department of Radiation Oncology
Brigham and Women’s Hospital
LJL declares that she has no competing interests.
Dr Richard T. Penson and Dr Larissa J. Lee would like to gratefully acknowledge Dr Neil S. Horowitz and Dr Anthony H. Russell, previous contributors to this topic.
Minimally Invasive Gynecologic Surgery
Magee Women's Hospital
University of Pittsburgh Medical Center
LY declares that she has no competing interests.
Consultant in Obstetrics & Gynaecology
Lead Clinician in Colposcopy
Imperial College Healthcare NHS Trust
DL declares that she has no competing interests.
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