Advantages and Disadvantages of the Different Methods to Perform Radical Hysterectomy (Open, Laparoscopic, Robotic) for Cervical Cancer

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Abstract The fourth most common disease in women is cervical cancer, with 660,000 new cases and 350,000 deaths in 2022. Low- and middle-income countries have the highest cervical cancer mortality. This reflects severe discrepancies caused by the lack of national HPV vaccination programmes, cervical screening, treatment services, and social and economic factors. Timely identification and intervention can potentially eradicate cervical cancer. Early-stage cervical cancer is generally managed through type III radical hysterectomy and bilateral pelvic lymph node dissection via the open technique. In some special circumstances, the choice of minimally invasive surgery (MIS) may offer various benefitsc, such as reduced blood loss, increased numbers of dissected lymph nodes, and shorter hospital stays. Laparoscopic and robotic hysterectomy are better than the open technique in terms of surgical outcomes, with better results observed in the robotic approach. Nevertheless, many research efforts suggest that robotic radical hysterectomy and lymph node dissection have similar perioperative lymphatic complications to laparoscopic surgery, with large tumours and parametrial invasion precluding the robotic approach. In addition to the various advantages and disadvantages of open surgery and MIS techniques for radical hysterectomy, node-positive early-stage cervical cancer exhibits differing responses to neoadjuvant and adjuvant therapies. Patients with early-stage cervical cancer exhibiting more than two positive lymph nodes or high-risk characteristics demonstrated improved survival rates when treated with consolidation chemotherapy after surgery. In countries with limited healthcare access and medical facilities, parametrectomy must be tailored to lymph node status and personalised, wherein clinical practice may even involve non-guideline cancer therapies.

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