The recommended treatment for early-stage cervical cancer (FIGO 2018 stages IA–IB2 and selected IIA1) is surgery, followed by either observation or adjuvant therapy, based on individual risk factors. Surgical management has evolved from extensive radical procedures to more conservative strategies, allowing for fertility-preserving options in appropriately selected patients. In 2018, a landmark study (LACC trial) evaluated the surgical approach to radical hysterectomy, comparing open vs. minimally invasive surgery. The results demonstrated that minimally invasive surgery was associated with worse disease-free and overall survival, leading to guidelines changes that recommend the open radical hysterectomy as the new standard of care. More recently, results from the prospective randomized SHAPE trial demonstrated that in well-selected patients with low-risk early-stage cervical cancer, recurrence rates are comparable between simple hysterectomy and radical hysterectomy. An ongoing study, the CONTESSA trial, is evaluating the role of neoadjuvant chemotherapy in the setting of fertility preservation for lesions measuring 2–4 cm. In addition, ongoing studies are evaluating different surgical approaches for both simple hysterectomy (LASH trial) and radical hysterectomy (ROCC/GOG-3043 and RACC trials), with a focus on comparing oncologic outcomes. Attention has also turned to refining lymph node assessment. Sentinel lymph node biopsy has become a standard staging strategy with reduced morbidity. The SENTICOL I-II and SENTIX/ENGOT-Cx2 trials support its safety and diagnostic accuracy in early-stage disease. This article offers a comprehensive overview of recently published prospective trials that have shaped clinical practice in the management of early-stage cervical cancer. It focuses on surgical approaches and radicality, the role of sentinel lymph node mapping, and fertility-sparing treatments. The review further draws attention to ongoing investigations and novel studies that may influence future directions in the field.
早期宫颈癌（FIGO 2018分期IA–IB2及部分IIA1期）的标准治疗方案为手术，术后根据个体风险因素选择观察或辅助治疗。手术治疗已从广泛根治性术式逐步发展为更保守的策略，为符合条件的患者提供了保留生育功能的选择。2018年一项里程碑研究（LACC试验）评估了根治性子宫切除术的手术路径，比较开腹手术与微创手术的效果。结果显示微创手术的无病生存期和总生存期更差，这促使指南更新，推荐开腹根治性子宫切除术作为新的标准治疗方案。近期，前瞻性随机SHAPE试验结果表明，在严格筛选的低风险早期宫颈癌患者中，单纯子宫切除术与根治性子宫切除术的复发率相当。目前正在进行的CONTESSA试验正在评估新辅助化疗在保留生育功能治疗中对2–4 cm病灶的作用。此外，多项研究正在评估单纯子宫切除术（LASH试验）和根治性子宫切除术（ROCC/GOG-3043和RACC试验）的不同手术路径，重点比较肿瘤学结局。淋巴结评估的精细化也受到关注。前哨淋巴结活检已成为标准分期策略，可降低并发症发生率。SENTICOL I-II和SENTIX/ENGOT-Cx2试验证实了其在早期宫颈癌中的安全性和诊断准确性。本文系统综述了近期发表的前瞻性试验，这些研究重塑了早期宫颈癌的临床实践，重点关注手术路径与根治程度、前哨淋巴结定位的作用以及保留生育功能的治疗。本综述进一步关注可能影响该领域未来方向的在研项目及创新研究。
Current Updates on Surgical Management of Patients with Early-Stage Cervical Cancer
肿瘤(癌症)患者之家