Risk-Adapted surgical treatment of early-stage cervical cancer: tailoring radicality, ovarian preservation, and surgical approach in the post-shape and post-lacc era — A review from the french cervical cancer guidelines group - 27/10/26
, Marion Deberti 1, Faustine Morineau 2, Xavier Carcopino 3, Witold Gertych 2the members from the FRENCH CERVICAL CANCER GUIDELINES GROUP
ABSTRACT |
Background |
Exclusive surgical treatment remains a cornerstone of management for selected patients with early-stage cervical cancer. However, the traditional paradigm of radical hysterectomy with systematic parametrial resection has been challenged by contemporary evidence supporting risk-adapted surgical de-escalation. In parallel, randomized and real-world data have raised major concerns regarding the oncologic safety of minimally invasive radical hysterectomy.
Methods |
A structured narrative review was conducted to summarize the available evidence on exclusive surgical treatment for early-stage cervical cancer. Predefined topics included the extent of hysterectomy and parametrial resection, ovarian preservation, surgical approach, and the comparative role of surgery versus chemoradiotherapy. Randomized trials, prospective studies, retrospective cohorts, meta-analyses, and relevant methodological reviews were included.
Results |
In early-stage cervical cancer, parametrial involvement is uncommon in well-selected low-risk patients. The SHAPE trial demonstrated the non-inferiority of simple hysterectomy compared with radical hysterectomy in low-risk disease, with lower urinary morbidity, supporting risk-adapted omission of parametrial resection. Ovarian preservation appears oncologically safe in young women with early-stage disease and no high-risk features, although caution is warranted in the presence of adverse factors such as uterine corpus involvement, lymphovascular space invasion, lymph node metastases, and non-squamous histology. Conversely, minimally invasive radical hysterectomy has been associated with inferior disease-free and overall survival compared with open surgery, despite reduced perioperative morbidity.
Conclusion |
Exclusive surgical treatment for early-stage cervical cancer should be guided by individualized risk assessment, combining parametrial de-escalation in low-risk disease, ovarian preservation when appropriate, and open surgery when radical hysterectomy is required.
Le texte complet de cet article est disponible en PDF.Keywords : Cervical cancer, Early stage, Radical hysterectomy, Hysterectomy, Minimally invasive surgery
Plan
| Authors from the FRENCH CERVICAL CANCER GUIDELINES GROUP: Xavier Carcopino 1* , Lobna Ouldamer 2 , Cyrille Huchon 3 , Pauline Asseeva 4 , Henri Azaïs 5 , Sofiane Bendifallah 6 , Jean-Luc Brun 7 , Geoffroy Canlorbe 8 , Cyrus Chargari 9 , Pauline Chauvet 10 , Abel Cordoba 11 , Hélène Courcier 12 , Yohann Dabi 13 , Marion de Berti 2 , Caroline Diguisto 2 , Eva Fuss 14 , Thomas Gaillard 15 Tristan Gauthier 16 , Witold Gertych 17 , Laurence Gladieff 18 , Olivier Graesslin 19 , Yohan Kerbage 20 , Martin Koskas 12 , Enora Laas 15 , Aymeline Lacorre 16 , Vincent Lavoué 21 , Lise Lecointre 14 , Fabrice Lecuru 22 , François Margueritte 16 , Alejandra Martinez 23 , Paul-Jean Maternowski 7 , Patrice Mathevet 24 , Imane Menouer 19 , Camille Mimoun 3 , Anthony Moureau 21 , Antoine Netter 1 , Charles-André Philip 25 , Pascal Rousset 26 , Claire Sanson 27 , Isabelle Thomassin-Naggara 28 , Cyril Touboul 13 , Jean Levêque 21 . |
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| Affiliations: |
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| 1.Department of Obstetrics and Gynaecology, Hôpital Nord, Assistance Publique–Hôpitaux de Marseille (APHM), CEReSS, Center for Studies and Research on Health Services and Quality of Life, Aix Marseille University (AMU), Marseille, France |
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| 2.Department of Gynecology , Centre Hospitalier Universitaire de Tours, INSERM U1069; Université François-Rabelais, Tours, France, |
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| 3.Department of Obstetrics and Gynaecology, Lariboisière Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris Cité University, Paris, France |
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| 4.Department of Nuclear Medicine, Hôpital Nord, Assistance Publique–Hôpitaux de Marseille (APHM), Marseille, France |
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| 5.Department of Gynecologic and Breast Cancer Surgery, Hôpital Européen Georges Pompidou, AP-HP, Paris Cité University, Paris, France |
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| 6.Department of Gynaecologic Surgery, American Hospital of Paris, Neuilly-sur-Seine, France |
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| 7.Department of Gynaecologic Surgery and Reproductive Medicine, Aliénor d’Aquitaine Center, Pellegrin Hospital, Bordeaux, France |
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| 8.Department of Gynaecologic and Breast Cancer Surgery, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Sorbonne University, Saint-Antoine Research Center (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Paris, France |
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| 9.Department of Radiation Oncology, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France |
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| 10.Department of Obstetrics and Gynaecology, Estaing University Hospital, Clermont Auvergne University, EnCoV, Institut Pascal, CNRS UMR 6602, SIGMA Clermont, Clermont-Ferrand, France |
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| 11.Department of Radiation Therapy, Centre Oscar Lambret, Lille, France |
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| 12.Department of Obstetrics and Gynaecology, Bichat Hospital, Paris Cité University, Paris, France |
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| 13.Department of Obstetrics and Gynaecology and Reproductive Medicine, Tenon Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France |
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| 14.Department of Gynaecologic Surgery, Hautepierre University Hospital, Strasbourg, France |
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| 15.Department of Gynaecologic, Breast and Reconstructive Surgery, Institut Curie, Paris, France |
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| 16.Department of Obstetrics and Gynaecology, Women, Mothers and Children Hospital (HFME), Limoges University Hospital, Limoges, France |
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| 17.Department of Gynaecologic and Oncologic Surgery, Lyon Sud Hospital, Lyon, France |
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| 18.Department of Medical Oncology, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France |
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| 19.Alix de Champagne Mother and Child Institute, Reims University Hospital, University of Reims Champagne-Ardenne (URCA), Reims, France |
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| 20.Department of Gynaecologic Surgery, Lille University Hospital, University of Lille, INSERM U1189, OncoThAI: Laser-Assisted Therapies and Immunotherapies for Oncology, Lille, France |
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| 21.Department of Gynaecology, Obstetrics and Human Reproduction, CHU Anne de Bretagne, Faculty of Medicine, University of Rennes, IRSET, INSERM U1085, Rennes, France |
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| 22.Department of Breast, Gynaecologic and Reconstructive Surgery, Institut Curie, Faculty of Medicine, Paris Cité University, Paris, France |
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| 23.Oncopole Claudius Regaud, Toulouse University Cancer Institute-Oncopole, Toulouse III–Paul Sabatier University, INSERM, CNRS, University of Toulouse, Toulouse Cancer Research Center, UMR1037, Toulouse, France |
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| 24.Lausanne University Hospital (CHUV), Lausanne, Switzerland; University of Lausanne (UNIL), Lausanne, Switzerland |
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| 25.Women and Children Hospital, Hospices Civils de Lyon (HCL), LabTAU INSERM U1032, Claude Bernard Lyon 1 University, Lyon, France |
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| 26.Department of Medical and Interventional Imaging, Lyon Sud University Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, EA CICLY, Lyon, France |
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| 27.Department of Gynaecologic Surgery, Paris Saint-Joseph Hospital Group, Paris, France |
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| 28.Department of Medical Imaging, Tenon Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France |
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