Simple Hysterectomy Effective for Low-Risk Early Cervical Cancer: JAMA

In the study, published in JAMA Network Open, Christopher M. Tarney, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, and colleagues analyzed data from 2,636 women diagnosed with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA2 or IB1 cervical cancer.

All participants had tumors no larger than 2 cm and no evidence of lymph node involvement. The women underwent one of three surgical procedures—simple hysterectomy (SH), modified radical hysterectomy (MRH), or radical hysterectomy (RH)—between January 2010 and December 2017. Survival was the study’s primary endpoint, evaluated over a median follow-up of 85 months.

The study revealed the following findings:

• There were no significant differences in long-term outcomes across the three surgical groups.
• Seven-year survival rates were 93.9% for simple hysterectomy (SH), 94.2% for modified radical hysterectomy (MRH), and 95.4% for radical hysterectomy (RH).
• Ten-year survival rates remained comparable, with 89.8% for SH and 91.7% for MRH or RH.
• Survival differences remained statistically nonsignificant even after adjusting for age, comorbidities, tumor grade, surgical margins, and adjuvant treatment.
• Propensity score balancing confirmed no significant increase in mortality risk with SH (adjusted hazard ratio: 1.19).
• Rates of positive surgical margins, lymphovascular space invasion, lymph node metastasis, and 30-day hospital readmission were similar across all surgical groups.
• These findings were consistent across various patient subgroups, including those stratified by age, race, comorbidity score, facility type, and tumor characteristics.

The study builds on earlier randomized clinical trial evidence, which showed no increase in pelvic recurrence rates among women undergoing simple hysterectomy for low-risk cervical cancer. However, previous trials lacked the statistical power to evaluate long-term survival. This current analysis, using real-world data from Commission on Cancer–accredited U.S. facilities, offers a more definitive insight.

Experts say these findings could influence surgical decision-making by supporting the use of less radical interventions in appropriately selected patients. For women with small, early-stage cervical tumors and no lymph node involvement, simple hysterectomy may offer a safe and effective alternative to more aggressive surgeries, with potentially fewer complications and faster recovery.

"The study offers strong evidence that simple hysterectomy can achieve long-term survival outcomes comparable to those of more extensive surgeries in patients with low-risk early-stage cervical cancer," the study authors concluded.

Reference:

Tarney CM, Tian C, Randall LM, et al. Long-Term Survival in Patients With Low-Risk Cervical Cancer After Simple, Modified, or Radical Hysterectomy. JAMA Netw Open. 2025;8(5):e2510717. doi:10.1001/jamanetworkopen.2025.10717