Surgical Treatment of Locally Advanced Cervical Cancer

Abdominal radical hysterectomy is the standard surgery for stage IB–IIB cervical cancer in the world. In locally advanced cervical cancer, there is no significant difference in survival rates between surgery and chemoradiotherapy, and there is no clear evidence for treatment strategies based on histological type, but surgery may be a viable option for less radiosensitive adenocarcinomas and special histological types of cancer (gastric-type mucinous and small cell neuroendocrine cancers) under the care of a physician sufficiently skilled in surgical techniques. Recently, the usefulness of nerve-sparing techniques has also been reported. The standard treatment for stage IVA cervical cancer is concurrent chemoradiotherapy, although pelvic exenteration can be chosen in cases where the tumor does not reach the pelvic wall and para-aortic lymph nodes are negative for cancer. On the other hand, less-invasive surgery can be considered for stage IB1 cervical cancer. In 2023, the efficacy and safety of modified radical hysterectomy for stage IB1 cervical cancer has been reported from the Japan Clinical Oncology Group (JCOG).