Survival After Simple Compared With Radical Hysterectomy for Patients With Early-Stage Cervical Cancer

We read with great interest the study published by Viveros-Carreño et al1 in the January 2025 issue, which supports the safety of performing simple hysterectomy instead of radical hysterectomy in patients with early-stage cervical cancer. Recently, the randomized SHAPE (Simple Hysterectomy and Pelvic Node Assessment) trial reported similar findings.2 An analysis of the retrospective cohort study of patients included in the National Cancer Database suggests that performing simple hysterectomy is associated with similar risks of surgery-related morbidity and long-term survival outcomes when compared with radical hysterectomy.1 Three key points warrant discussion. First, no specific data on the extent of the surgery are reported. The degree of radicality could affect the observed results. Furthermore, it is important to consider that type A radical hysterectomy (“limited radical hysterectomy”) might have been classified within both the simple and radical hysterectomy groups.3,4 Second, the simple hysterectomy group showed higher rates of adjuvant therapy administration. It would be interesting to investigate how many patients in each group had positive surgical margins and the criteria adopted for selecting adjuvant treatments.5 Lastly, as observed in the SHAPE trial, patients undergoing simple hysterectomy were more likely to have minimally invasive surgery.1,2 It would also be valuable to know how many patients had residual disease at the time of hysterectomy. These findings open new considerations regarding the role of minimally invasive surgery in the management of low-risk cervical cancer.