Cervical cancer treatment: Minimally invasive radical hysterectomy vs. abdominal hysterectomy

Abdominal radical hysterectomies (also called “open” hysterectomies) typically are thought of as more difficult for patients to recover from than a minimally invasive radical hysterectomy. But new research shows they’re safer for early-stage cervical cancer patients.

MD Anderson gynecologic oncologists led two studies looking at the two techniques:

• abdominal radical hysterectomy: the more traditional method of surgery in which surgeons remove the uterus and other surrounding structures,  through an incision in the patient’s lower abdomen
• minimally invasive radical hysterectomy: when surgeons conduct a surgery using very small incisions and remove the uterus and surrounding parts

They found that cervical cancer patients who had minimally invasive radical hysterectomies were four times more likely to experience recurrence than those who had open surgery. They also had lower survival rates.

As a result of the studies' findings, MD Anderson gynecologic oncologists made the decision to no longer perform minimally invasive radical hysterectomies on cervical cancer patients. Our physicians recommend that these patients undergo open abdominal radical hysterectomies instead.  

We spoke with Pedro Ramirez, M.D., a gynecologic oncologist and surgeon who led one of the studies, about what else patients should know about surgery for cervical cancer treatment. Here’s what he had to say. 

What’s the difference between a radical hysterectomy and a simple hysterectomy?

In a simple hysterectomy, the uterus is removed. In a radical hysterectomy, the uterus and some surrounding parts around the cervix are removed.  The open radical hysterectomy is performed by removing the uterus through an incision (similar to the one made in a C-section) in the lower abdomen. Radical hysterectomies typically are used in cancer treatment to ensure that all of the cancer is removed.

Who needs a radical hysterectomy for cervical cancer treatment?

A radical hysterectomy is the standard treatment for early-stage cervical cancer. That includes stage I cervical cancer, and more specifically, stage IA2 and IB1. Often these patients are younger, between ages 20 and 40. Surgery is not the standard of care for advanced-stage cervical cancer patients. Typically, these patients receive radiation and chemotherapy.

What should cervical cancer patients who’ve already had a minimally invasive radical hysterectomy know?

Patients who’ve had a minimally invasive radical hysterectomy for cervical cancer treatment have an 8% chance of the cancer coming back. In other words, one out of 10 patients will have a recurrence.

If you’ve had a minimally invasive radical hysterectomy, talk to your gynecologic oncologist about what next steps are best for you. This may or may not mean more follow-up appointments and possibly additional imaging. The important thing is that you talk with your doctor and decide what’s best for you.

Are minimally invasive hysterectomies still safe for patients with other types of gynecologic cancers, like uterine cancer and ovarian cancer?

Yes, they are. Other studies show that minimally invasive hysterectomies are still safe for uterine cancer. We’re not completely sure of the reason why, but we think it has to do with the biological makeup of the tumor. Regardless, it remains the standard of care for uterine cancer.

Minimally invasive surgery is only routinely performed to determine what type of treatment (surgery or chemotherapy) is needed next in patients with advanced ovarian cancer.

What should patients preparing for an abdominal radical hysterectomy expect?

Thanks to our enhanced surgical recovery programs at MD Anderson, we’ve been able to make dramatic improvements in recovery time from hysterectomies. Patients used to stay in the hospital for four to five days after surgery. Now patients can go home the next day. They experience less pain and are able to resume their normal activities more quickly.

If you’re preparing for an abdominal radical hysterectomy, choose a hospital with an enhanced surgical recovery program.

If your doctor suggests a minimally invasive radical hysterectomy for cervical cancer, discuss the study results and seek a second opinion.

Regardless of what type of cancer you have, talk to your doctor about any questions or concerns you have about an upcoming surgery. Your oncologist can address those concerns and help find the treatment that’s best for you.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.