Clinical Practice Guidelines 

This update refers to Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Marth C, Landoni F, Mahner S et al. Ann Oncol 2017; 28 (Suppl 4): iv72–iv83. 

Management of local/locoregional disease; primary treatment 

In the ESMO Clinical Practice Guidelines on cervical cancer, radical hysterectomy with bilateral lymph node dissection [with or without sentinel lymph node (SLN)], carried out either by laparotomy or laparoscopy, was regarded as a standard treatment in patients with FIGO (Fédération Internationale de Gynécologie et d’Obstétrique) stage IA2, IB and IIA, if the patient does not wish to preserve fertility. Results of the recent published randomised, phase III trial LACC make it necessary to amend the statement [1]. In this trial, 631 patients with stage IA1 (lymphovascular invasion), IA2 or IB1 cervical cancer, and a histological subtype of squamous- cell carcinoma, adenocarcinoma, or adenosquamous carcinoma were randomly assigned to undergo minimally invasive surgery (laparoscopy or robot-assisted surgery) or conventional open surgery. Minimally invasive surgery was associated with a lower rate of disease-free survival (DFS) than open surgery [3-year rate, 91.2% versus 97.1%; hazard ratio (HR) for disease recurrence or death from cervical cancer 3.74; 95% confidence interval (CI) 1.63–8.58], a difference that remained after adjustment for prognostic factors. Minimally invasive surgery was also associated with a lower rate of overall survival (OS) (3-year rate, 93.8% versus 99.0%; HR for death from any cause 6.00; 95% CI 1.77–20.30). These findings were confirmed in an epidemiological study, indicating that minimally invasive radical hysterectomy was associated with shorter OS than open surgery among women with stage IA2 or IB1 cervical carcinoma [2]. 

Radical hysterectomy performed by laparoscopy or robot-assisted surgery cannot be regarded as the preferred treatment in comparison with open surgery in patients with FIGO stage IA2, IB, and IIA [I, E]. Patients should be counseled about the risks and benefits of the different types of surgery. 

Ramirez PT, Frumovitz M, Pareja R et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 2018; 379:1895–1904. 2. Melamed A, Margul DJ, Chen L et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med 2018; 379: 1905–1914.