Open Radical Hysterectomy: The New Standard of Care in Early-Stage Cervical Cancer.

The current standard in the surgical management of patients with early-stage cervical cancer is open radical hysterectomy. Results from the LACC trial have demonstrated that minimally invasive radical hysterectomy is associated with worse disease-free and overall survival compared to the open approach. Subsequent data from this prospective trial demonstrated no difference in global adverse events nor in quality of life when comparing the two surgical approaches. Recent retrospective studies have shown that the vaginal protective maneuver may render an advantage by decreasing tumor exposure and spillage in the setting of laparoscopic-assisted vaginal hysterectomy. However, oncologic outcomes have not been evaluated when prospectively implementing this technique. The minimally invasive approach has demonstrated inferior outcomes even in the setting of small tumors (<2 cm). There are currently three ongoing prospective trials comparing open vs minimally invasive radical hysterectomy.