Jose Alejandro Rauh-Hain, MD, MPH

“This is an impressive presentation,” said formal discussant Jose Alejandro Rauh-Hain, MD, MPH, of The University of Texas MD Anderson Cancer Center, Houston.

“Radical hysterectomy has intraoperative and postoperative complications that include gastrointestinal and genitourinary long-term complications, sexual dysfunction, and financial toxicity. Also, these results have training implications for low-resource countries, which have more than 85% of cervical cancer cases,” he explained.

The single-arm ConCerv trial conducted at MD Anderson Cancer Center, showed that conservative surgery could be safely and effectively done in 100 selected patients with early-stage, low-risk disease. A second study done in Brazil with 40 patients also showed no difference in 3-year disease-free survival for the two surgical approaches. “All three studies point in the same direction. The key message is the importance of patient selection. Moving forward, for patients who fit these very specific criteria, we can perform simple hysterectomy instead of radical hysterectomy,” Dr. Rauh-Hain said.

“Remaining questions include the following: Which patients are the ideal candidates for simple hysterectomy? What is the future of radical hysterectomy? Will it be used on only 2-cm to 4-cm tumors? Ongoing trials of minimally invasive vs open surgery will help to answer these questions,” he said.

“For now, simple hysterectomy should become the standard of care for low-risk early-stage cervical cancer in tumors smaller than 2 cm that meet the other criteria for entry into this trial,” Dr. Rauh-Hain stated. 

DISCLOSURE: Dr. Rauh-Hain has served as a consultant for the Schlesinger Group and Guidepoint.