Balancing survival and surgical innovation: a narrative review of abdominal vs. minimally invasive radical hysterectomy in cervical cancer
Manahil Mubeen, Saim Mahmood Khan, Jawairya Muhammad Hussain, Muhammad Affan Abid, Eman Rashid, Faris Ahmed, Reham Jamal, Sijan Poudel, Manisha Pokhrel, Surraiya Riaz MahmoodIntroduction:
Cervical cancer remains a significant global health problem for women. The main treatment for early-stage illness is often a radical hysterectomy. Each of the two primary surgical approaches, minimally invasive radical hysterectomy (MIRH) and abdominal radical hysterectomy (ARH), has specific benefits and disadvantages. MIRH is linked to a faster recovery and reduced postoperative pain, however, concerns have arisen about its long-term oncological safety, especially following studies such as the Laparoscopic Approach to Cervical Cancer (LACC) trial.
Aim:
The aim of this narrative report is to assess and compare ARH and MIRH, focusing on complications, surgical results, survival data, relapse data, effects on quality of life, and cost analysis, with the final goal of optimizing the management of cervical cancer.
Methods:
We performed a detailed narrative review, integrating the results from retrospective investigations, meta-analyses, key trials including the LACC trial, and other epidemiological studies. Intraoperative and postoperative complications, overall survival (OS), disease-free survival (DFS), and patient-reported quality of life are among the important outcomes evaluated. Improvements in MIRH methods and preventative measures meant to reduce tumor dissemination are also highlighted in the review.
Results:
MIRH is associated with reduced blood loss, shorter hospitalization, and fewer minor complications. However, evidence from LACC trial reporting a 4-year DFS rate of 86% for MIRH versus 96% for ARH, along with other supporting studies suggests that long-term oncological outcomes (relapses and mortality) are generally less favorable with MIRH compared to ARH, particularly in patients with larger tumors or high-risk profiles.
Conclusion:
MIRH may remain a viable option in carefully selected patients when sufficient oncological precautions are taken, even if ARH continues to be regarded as the preferred standard approach in cervical cancer surgery. The choice of surgical approach should be individualized, considering patient factors such as tumor size, overall health, and preferences. Further research is necessary to improve MIRH’s safety profile and strengthen its role in the treatment of cervical cancer.