Part of the book series: Comprehensive Gynecology and Obstetrics ((CGO))

  • 104 Accesses

Abstract

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).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
EUR 29.95
Price includes VAT (Germany)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
EUR 117.69
Price includes VAT (Germany)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
EUR 149.79
Price includes VAT (Germany)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Long Y, et al. Clinical efficacy and safety of nerve-sparing radical hysterectomy for cervical cancer: a systematic review and meta-analysis. PLoS One. 2014;9:e94116.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Roh JW, et al. Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer: a randomized controlled trial. J Gynecol Oncol. 2015;26:90–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Fujii S, et al. Anatomic identification and functional outcomes of the nerve sparing Okabayashi radical hysterectomy. Gynecol Oncol. 2007;107:4–13.

    Article  PubMed  Google Scholar 

  4. Konishi I. The Okabayashi radical hysterectomy: basic principle and step-by-step procedure. Surg J (N Y). 2021;7(Suppl 2):S57–69.

    PubMed  Google Scholar 

  5. Landoni F, et al. Randomised study of radical surgery versus radiotherapy for stage IB-IIA cervical cancer. Lancet. 1997;350:535–40.

    Article  CAS  PubMed  Google Scholar 

  6. Brewster WR, et al. Intent-to-treat analysis of stage Ib and IIa cervical cancer in the United States: radiotherapy or surgery 1988-1995. Obstet Gynecol. 2001;97:248–54.

    CAS  PubMed  Google Scholar 

  7. Rungruang B, et al. Surgery versus radiation therapy for stage IB2 cervical carcinoma: a population-based analysis. Int J Gynecol Cancer. 2012;22:484–9.

    Article  PubMed  Google Scholar 

  8. Ross Green W, et al. Revisiting milan cervical cancer study: do the original findings hold in the era of chemotherapy? Gynecol Oncol. 2017;144:299–304.

    Article  CAS  PubMed  Google Scholar 

  9. Rose PG, et al. Locally advanced adenocarcinoma and adenosquamous carcinomas or the cervix compared to squamous cell carcinomas of the cervix in gynecologic oncology group trials of cisplatin-based chemoradiation. Gynecol Oncol. 2014;135:208–12.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Matsuo K, et al. Association of radical hysterectomy surgical volume and survival for early-stage cervical cancer. Obstet Gynecol. 2019;133:1086–98.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Japan Society of Gynecologic Oncology. Guidelines for treatment of uterine cervical cancer: Japan Society of Gynecologic Oncology (JSGO) 2022 edition.

    Google Scholar 

  12. Gupta S, et al. Neoadjuvant chemotherapy followed by radical surgery versus concomitant chemotherapy and radiotherapy in patients with stage IB2, IIA, or IIB squamous cervical cancer: a randomized controlled trial. J Clin Oncol. 2018;36:1548–55.

    Article  CAS  PubMed  Google Scholar 

  13. Kenter G, et al. Results from neoadjuvant chemotherapy followed by surgery compared to chemoradiation for stage Ib2-IIb cervical cancer, EORTC55994. J Clin Oncol. 2019;37:5503.

    Article  Google Scholar 

  14. Cervical Cancer Guideline (Version 1, 2021). NCCN clinical practice guidelines in oncology.

    Google Scholar 

  15. International Agency for Research on Cancer. WHO classification of tumors of female reproductive organs. 5th ed. Lyon: IARC Press; 2019.

    Google Scholar 

  16. Mikami Y, et al. Gastrointestinal immunophenotype in adenocarcinomas of the uterine cervix and related glandular lesions: a possible link between lobular endocervical glandular hyperplasia/ pyloric gland metaplasia and ‘Adenoma malignum’. Mod Pathol. 2004;17:962–72.

    Article  PubMed  Google Scholar 

  17. Kojima A, et al. Gastric morphology and immunophenotype predict poor outcome in mucinous adenocarcinoma of the uterine cervix. Am J Surg Pathol. 2007;31:664–72.

    Article  PubMed  Google Scholar 

  18. Nishio S, et al. Analysis of gastric-type mucinous carcinoma of the uterine cervix- an aggressive tumor with a poor prognosis: a multi-institutional study. Gynecol Oncol. 2019;153:13–9.

    Article  PubMed  Google Scholar 

  19. Kojima A, et al. Chemoresistance of gastric-type mucinous carcinoma of the uterine cervix: a study of the Sankai gynecology study group. Int J Gynecol Cancer. 2018;28:99–106.

    Article  PubMed  Google Scholar 

  20. Temper CB, et al. Neuroendocrine carcinoma of the cervix: a systematic review of the literature. BMC Cancer. 2018;18:530–46.

    Article  Google Scholar 

  21. Gadducci A, et al. Neuroendocrine tumors of the uterine cervix: a therapeutic challenge for gynecologic oncologists. Gynecol Oncol. 2017;144:637–46.

    Article  PubMed  Google Scholar 

  22. Tanaka S, et al. Clinical outcome of pelvic exenteration in patients with advanced or recurrent uterine cervical cancer. Int J Clin Oncol. 2014;19:133–8.

    Article  PubMed  Google Scholar 

  23. Marnitz, et al. Indications for primary and secondary exenterations in patients with cervical cancer. Gynecol Oncol. 2006;103:1023–30.

    Article  PubMed  Google Scholar 

  24. Forner DM, et al. Exenteration as a primary treatment for locally advanced cervical cancer: long-term results and prognostic factors. Am J Obstet Gynecol. 2011;205(148):e1–6.

    Google Scholar 

  25. Chiantera V, et al. Survival after curative pelvic exenteration for primary or recurrent cervical cancer: a retrospective multicentric study of 167 patients. Int J Gynecol Cancer. 2014;24:916–22.

    Article  PubMed  Google Scholar 

  26. Ungar L, et al. Primary pelvic exenteration in cervical cancer patients. Gynecol Oncol. 2008;111(2 Suppl):S9–12.

    Article  PubMed  Google Scholar 

  27. Schmidt AM, et al. Indications and long-term clinical outcomes in 282 patients with pelvic exenteration for advanced or recurrent cervical cancer. Gynecol Oncol. 2012;125:604–9.

    Article  PubMed  Google Scholar 

  28. Jason G, et al. Literature review: double-Barrelled wet colostomy (one stoma) versus Ileal conduit with colostomy (two stomas). Urol Int. 2017;98:249–54.

    Article  Google Scholar 

  29. Kunieda F, et al. Non-randomized confirmatory trial of modified radical hysterectomy for patients with tumor diameter 2 cm or less FIGO stage IB1 uterine cervical cancer: Japan Clinical Oncology Group Study (JCOG1101). Jpn J Clin Oncol. 2015;45:123–6.

    Article  PubMed  Google Scholar 

  30. Arimoto T et al. A confirmatory trial of modified radical hysterectomy for FIGO Stage IB1 cervical cancer patients with tumor diameter preoperatively estimated 2 cm or less: Japan Clinical Oncology Group Study, JCOG1101. ASCO2023.

    Google Scholar 

  31. Sartori E, et al. Extended radical hysterectomy in early-stage carcinoma of the uterine cervix: tailoring the radicality. Int J Gynecol Cancer. 1995;5:143–7.

    Article  PubMed  Google Scholar 

  32. Kinney WK, et al. Identification of a low-risk subset of patients with stage IB invasive squamous cancer of the cervix possibly suited to less radical surgical treatment. Gynecol Oncol. 1995;57:3–6.

    Article  CAS  PubMed  Google Scholar 

  33. Kristensen GB, et al. Tumor size, depth of invasion, and grading of the invasive tumor front are the main prognostic factors in early squamous cell cervical carcinoma. Gynecol Oncol. 1999;74:245–51.

    Article  CAS  PubMed  Google Scholar 

  34. Noda K, et al. Kee** of vesical and rectal functions after radical operation of uterine cervical cancer. Acta Obstet Gynaecol Jpn. 1972;24:99–106.

    CAS  Google Scholar 

  35. Matuzawa M. Urination disorder and function preserving surgery in gynecology. In: Kotsuban Geka. Tokyo: Ishiyaku Publishers; 1982; (in Japanese).

    Google Scholar 

  36. Yamabe T. Hysterectomy for primary uterine cervical cancer (modified radical hysterectomy—provisional title). Sanfu**ka Chiryou. 1974;28:599–606; (in Japanese).

    Google Scholar 

  37. Yang YC, et al. Modified radical hysterectomy for early Ib cervical cancer. Gynecol Oncol. 1999;74:241–4.

    Article  CAS  PubMed  Google Scholar 

  38. Kato T, et al. Clinical tumor diameter and prognosis of patients with FIGO stage IB1 cervical cancer (JCOG0806-A). Gynecol Oncol. 2015;137:34–9.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Takahide Arimoto .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2024 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Arimoto, T. (2024). Surgical Treatment of Locally Advanced Cervical Cancer. In: Aoki, D. (eds) Recent Topics on Prevention, Diagnosis, and Clinical Management of Cervical Cancer. Comprehensive Gynecology and Obstetrics. Springer, Singapore. https://doi.org/10.1007/978-981-99-9396-3_8

Download citation

  • DOI: https://doi.org/10.1007/978-981-99-9396-3_8

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-9395-6

  • Online ISBN: 978-981-99-9396-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Navigation