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Less extensive surgery may be safe for early cervical cancer

Low-risk cervical cancer can safely be treated with a less radical operation than what patients have generally undergone, according to results from a 700-patient trial.

All of the participants had early-stage tumors measuring no more than 2 centimeters, with minimal invasion of nearby tissues.

Half underwent a so-called simple hysterectomy, in which the uterus and the cervix were removed. The others underwent the standard radical hysterectomy, in which surgeons removed the uterus and cervix, parts of surrounding tissues and ligaments, and 1-to-2 cm of the upper part of the vagina.

With a median follow-up time of 4.5 years, the incidence of pelvic recurrence of cancer at 3 years was 2.17% in the radical hysterectomy group and 2.52% in the simple hysterectomy group, a difference that was not statistically significant, according to a report published in The New England Journal of Medicine.

Rates of urinary incontinence were lower in the simple hysterectomy group than in the radical group within four weeks after surgery (2.4% vs 5.5%) and beyond four weeks (4.7% vs 11.0%).

Urinary retention was also less common after simple hysterectomy within and beyond four weeks at 0.6%. For radical hysterectomy, it was 9.9% and 11%, respectively.

The researchers note that among the limitations of the study is that minority women were underrepresented so results cannot be generalized to all populations.

While half the patients were followed for more than 4.5 years, disease recurrence beyond this time frame is still possible, they noted.