Lena Steinkasserer, Lisa Marie Wilhelm, Julie Schambach, Henning Schäffler, Morva Tahmasbi Rad, Fabienne Schochter, Davit Bokhua, Zoe Huber, Peter Hillemanns, Hermann Hertel, Chiara Flethe, Klaus Pietzner, Jalid Sehouli
This multicenter study provides a comprehensive overview of contemporary surgical management of early-stage cervical cancer in Germany. Surgical practice changed substantially over time, likely reflecting the combined influence of emerging clinical evidence, evolving guideline recommendations, and changing treatment paradigms; however, no uniform operative standard has emerged. Favorable perioperative and oncologic outcomes across approaches highlight the importance of patient selection and surgical expertise in contemporary cervical cancer care.
BACKGROUND: Surgical management of early-stage cervical cancer has evolved substantially over the past decade. While the LACC trial raised concerns regarding minimally invasive radical hysterectomy, real-world practice continues to include radical, non-radical, and fertility-sparing approaches. This study evaluated operative strategies and temporal trends in Germany, particularly regarding the impact of the LACC trial.
METHODS: This retrospective multicenter study included 391 patients with early-stage cervical cancer (≤pT1, pN0, FIGO < IB1) treated at four German university hospitals between 2014 and 2024. Demographic, surgical, perioperative, oncologic, and follow-up data were analyzed descriptively, focusing on temporal changes in surgical management.
RESULTS: The median age at diagnosis was 44 years, and 95.9% of patients had an ECOG performance status of 0-1. Pathological staging revealed pT1b1 tumors in 56.0% of cases, while microinvasive disease (pT1a1-a2) accounted for 35.3%. Laparoscopic approaches declined from 66.5% before 2019 to 50.0% thereafter following publication of the LACC trial in 2018 (p < 0.001), with a corresponding increase in open surgery. Fertility-sparing procedures remained stable (conization 11.3%, trachelectomy 7.4%). Perioperative morbidity was low, with no postoperative complications in 84.4% of patients. Disease recurrence occurred in 5.9% of patients.
CONCLUSIONS: This multicenter study provides a comprehensive overview of contemporary surgical management of early-stage cervical cancer in Germany. Surgical practice changed substantially over time, likely reflecting the combined influence of emerging clinical evidence, evolving guideline recommendations, and changing treatment paradigms; however, no uniform operative standard has emerged. Favorable perioperative and oncologic outcomes across approaches highlight the importance of patient selection and surgical expertise in contemporary cervical cancer care.