Open Radical Hysterectomy tied to superior Disease-Free Survival in Cervical Cancer: Study

A new study published in the journal of BMC Surgery showed that when compared to less invasive methods, open radical hysterectomy is linked to better disease-free survival.

Due to its obvious short-term advantages, such as less intraoperative blood loss, shorter hospital stays, and faster overall recovery periods, minimally invasive surgery (MIS), was historically quite popular.

However, results of clinical trial showed that MIS is surprisingly linked to increased recurrence risks and worse rates of disease-free survival when compared to conventional open surgery. As a result, the open laparotomy method is strongly recommended by current international clinical recommendations for the majority of patients, leading to a significant global reevaluation of surgical standards.

When comparing open versus minimally invasive radical hysterectomy, it is important to strike a careful balance between the better long-term oncological safety of open surgery and the immediate post-operative quality-of-life advantages of MIS. This research examined how current cervical cancer therapy is influenced by stringent patient selection, tumor size, and developing technology. The effect of open vs minimally invasive radical hysterectomy on survival outcomes in individuals with cervical cancer was assessed in this study.

The Cochrane Library, Web of Science, and PubMed databases were searched for pertinent material published during the last ten years. Included were clinical trials that contrasted MIS with open radical hysterectomy (ORH). The Newcastle-Ottawa Scale and the Cochrane Risk of Bias 2.0 instrument were used to evaluate the quality of the study. Subgroup analysis stratified by tumor size (≤ 2 cm vs. > 2 cm) was used in a meta-analysis to assess survival results between ORH and MIS.

The inclusion criteria were satisfied by fifteen clinical trials. Every observational study received a Newcastle-Ottawa Scale score of at least 7. When compared to MIS, patients receiving ORH had a substantially better 5-year disease-free survival (OR = 1.70 [1.27, 2.27], P < 0.001, I2 = 58%).

Overall survival, however, did not significantly differ between the two surgical techniques (OR = 1.08 [0.90, 1.15], P > 0.05). Regardless of tumor size, subgroup analysis revealed no significant differences in overall survival between ORH and MIS (≤2 cm: HR = 1.10 [0.28, 4.31], P = 0.89; >2 cm: HR = 0.82 [0.38, 1.77], P = 0.61).

Overall, although overall survival rates did not significantly differ between the two surgical techniques, open radical hysterectomy is linked to better disease-free survival. This suggests that although open surgery may lower the risk of recurrence, it does not seem to provide a clear long-term survival advantage.

Source:

Wu, J., Li, R., & Chen, H. (2026). Comparison of open and minimally invasive radical hysterectomy for cervical cancer: a systematic review and meta-analysis of survival outcomes. BMC Surgery. https://doi.org/10.1186/s12893-026-03878-0