Balancing Radicality and Function: Prospective Long-Term Outcomes of Muallem Nerve-Sparing Radical Hysterectomy Guided by an Anatomy-Oriented Classification

<b>Background/Objectives</b>: Radical hysterectomy remains the standard treatment for early-stage cervical cancer. Building on a precise understanding of pelvic anatomy, we previously described a novel nerve-sparing radical hysterectomy technique and classification. This study aims to present the long-term surgical, functional, and oncological outcomes of this approach and to validate its effectiveness in clinical practice. <b>Methods</b>: Between January 2020 and December 2024, consecutive patients with newly diagnosed cervical cancer who underwent nerve-sparing radical hysterectomy using the Muallem technique were prospectively included in the study. The surgical, functional, and oncological outcomes of these patients were assessed and analyzed. <b>Results:</b> Of the 74 eligible patients, 61 met the inclusion criteria. The cohort predominantly presented with advanced "Fédération Internationale de Gynécologie et d'Obstétrique (FIGO)" stages (23% IIB, 16% IIIC1r). The median tumor size was 3.9 cm (range: 0.5-7.5 cm). The median estimated blood loss was 210 mL, and the median hospital stay was 10 days. Complete recovery of bladder function was observed in all patients within two weeks. Five-year progression-free survival (PFS) and overall survival (OS) rates were 80.6% and 91.9%, respectively. <b>Conclusions</b>: In a cohort enriched with high-risk features, the Muallem nerve-sparing radical hysterectomy was associated with low intraoperative complication rates, minimal blood loss, and excellent functional outcomes. Survival outcomes demonstrated encouraging results, remaining consistent with the upper range of those reported in previously published standard-treatment series. The Muallem classification allowed for tailored surgical radicality without compromising oncological safety.