Key messages

• Simple hysterectomy may result in little to no difference in the number of deaths from any cause, life expectancy after treatment, deaths from cancer, cancer-free period after treatment, or the rate at which cancer returned compared to radical hysterectomy.

• Simple hysterectomy likely reduces unwanted adverse effects from surgery.

• Women undergoing simple hysterectomy may have better sexual health and overall well-being compared to those who undergo radical hysterectomy.

What is a surgical treatment of early-stage cervical cancer?

Radical hysterectomy is generally considered a standard surgical treatment for women with early-stage cervical cancer. Radical hysterectomy involves the removal of the womb, cervix (neck of the womb), surrounding tissues (parametrial tissue), and part of the vagina. Unwanted side effects from surgery include injury to the bowel, bladder, blood vessels, ureters (the tubes that transport urine from the kidneys to the bladder), and nerves, resulting in difficulty in bladder emptying and false track (fistula) formation.

What did we want to find out?

Since small cervical cancers are unlikely to spread to nearby tissues, a simple hysterectomy—which removes only the uterus and cervix—could be a suitable choice instead of a radical hysterectomy. Compared with radical surgery, a simple hysterectomy avoids unnecessary removal of surrounding tissues, which may avoid the risk of damage to nerves and the ureters. However, as simple hysterectomy removes a smaller margin of normal tissue around the cervix, there may be a higher risk that the cancer is not completely removed. Therefore, we want to find out if a simple hysterectomy is a safe and effective alternative compared to a radical hysterectomy for women with small cervical cancers.

What did we do?

We looked for studies that compared the health outcomes of women who were randomly assigned to have either a simple hysterectomy or a radical hysterectomy, both with the removal of pelvic lymph nodes. We focused on women with cervical cancer in stages IA2 to IB1. Stage IA2 means the cancer has grown 3 mm to 5 mm into the cervix, and stage IB1 means the cancer has grown more than 5 mm into the cervix but is no larger than 2 cm and has not spread beyond it.

What did we find?

We found two studies including 740 women. One small study (40 women) was conducted in Brazil. The larger study, involving 700 women, included centres in Western Europe, South Korea, and Canada. In this larger trial, three-quarters of the included women were white.

The results showed that simple hysterectomy might not change the number of deaths from any cause, life expectancy after treatment, cancer-free period after treatment, or the rate at which cancer returns compared to radical hysterectomy. In addition, simple hysterectomy might not increase deaths from cancer when compared to radical hysterectomy, but the evidence is very uncertain. Simple hysterectomy likely resulted in fewer unwanted side effects from surgery.

Women who underwent simple hysterectomy appeared to have better sexual health and overall well-being. Also, simple hysterectomy was less expensive than radical hysterectomy.

What are the limitations of the evidence?

We are not very confident in the evidence. The two included studies only gathered information over a short period of time about how long it takes for someone to die or for cancer to come back. Also, not many non-white women or women from low-resource settings were included. The studies did not control for differences in surgical methods (open surgery and minimal access ‘keyhole’ surgery), which might affect rates of cancer coming back and side effects of surgery. Currently, we do not know the best type and route of surgery for women with cervical cancer who have small tumours and limited invasion (shallow spreading into the deeper layers of the cervix), and more studies are needed to find out.

How up-to-date is this evidence?

The evidence is current to March 2025.