What is a Radical Hysterectomy?
A radical hysterectomy is a type of surgery used to treat certain gynecological cancers, like cervical cancer. In this procedure, the surgeon removes the uterus, cervix, and part of the vagina, along with the tissue surrounding the cervix (called the parametrium). If needed, the surgeon may also remove the ovaries, fallopian tubes, and nearby lymph nodes. The main difference between a simple and a radical hysterectomy is that in a simple hysterectomy only uterus and cervix are removed without the parametrium, which is associated with less operative complications.
Simple and Radical Hysterectomy
SHAPE Trial
This trial compared two types of surgeries for cervical cancer. It focused on women with early-stage cervical cancer who had a low risk of the cancer returning.
Most people with early-stage cervical cancer are treated with a radical hysterectomy, which is an extensive surgery with possible side effects. But doctors have wondered if a less aggressive surgery could be a safe and effective option. The study wasn’t trying to find out which surgery was better but to see if the simpler surgery was just as good as the radical one at preventing cancer from coming back.
Outcome
In the study, 700 patients with early-stage cervical cancer had either a radical hysterectomy or a simple hysterectomy. Three years after the surgeries, cancer had returned in the pelvic area for less than 3% of patients, no matter which surgery they had. However, patients who had the simple hysterectomy experienced fewer side effects, like urinary problems, compared to those who had the radical hysterectomy. They also reported a better quality of life.
Conclusion
In carefully selected patients, both simple and radical hysterectomy have similarly low rates of cancer returning after three years of follow-up. But the simpler surgery led to fewer complications and a better quality of life.
Referencies:
1. Plante, M., Kwon, J. S., Ferguson, S., Samouëlian, V., Ferron, G., Maulard, A., de Kroon, C., Van Driel, W., Tidy, J., Williamson, K., Mahner, S., Kommoss, S., Goffin, F., Tamussino, K., Eyjólfsdóttir, B., Kim, J. W., Gleeson, N., Brotto, L., Tu, D., Shepherd, L. E., … CX.5 SHAPE Investigators (2024). Simple versus Radical Hysterectomy in Women with Low-Risk Cervical Cancer. The New England journal of medicine, 390(9), 819–829. https://doi.org/10.1056/NEJMoa2308900
