Indications and technique of minimally invasive surgery in early-stage cervical cancer.

Abstract

Purpose of review: This review explores the evolving role of minimally invasive surgery (MIS) in early-stage cervical cancer following the landmark LACC trial, which shifted the standard of care back to open surgery. We revisit critical evidence, dissect controversial subgroups, and highlight areas where MIS may still hold clinical value.

Recent findings: Subgroup analyses and recent prospective trials suggest that MIS may remain a viable option for selected patients with low-risk tumours (<2 cm), particularly when preceded by conisation and incorporating protective surgical strategies. The SHAPE trial demonstrated noninferiority of simple hysterectomy compared to radical hysterectomy in these cases, and post hoc analyses indicate comparable outcomes between MIS and open approaches in this context. Additional real-world studies, such as SUCCOR and SUCCOR-Cone, underscore the potential protective role of preoperative conisation and specific intraoperative techniques. Nonetheless, all these findings remain hypothesis-generating and require validation.

Summary: While open surgery remains the current standard for early-stage cervical cancer, evidence is emerging that selected patients with low-risk features might safely undergo MIS, especially within the framework of clinical trials. Ongoing studies are expected to redefine surgical paradigms and guide future practice.