In the treatment of early-stage cervical cancer, minimally invasive radical hysterectomy should not be used for tumours 2 cm or larger and should only be used for smaller tumours within a research context, states new guidance from NICE.
The interventional procedures guidance states that the evidence on efficacy for tumours 2 cm or larger shows that minimally invasive radical hysterectomy is associated with shorter disease-free and overall survival compared with open hysterectomy surgery. Therefore, this procedure should not be used for tumours 2 cm or above.
The evidence on efficacy for tumours smaller than 2 cm is inconclusive for both disease-free and overall survival compared with open hysterectomy surgery. Therefore, NICE recommends, for tumours smaller than 2 cm, this procedure should only be used in the context of research.
This guidance replaces NICE interventional procedures guidance on laparoscopic radical hysterectomy for early-stage cervical cancer (IPG338).
The appraisal process included a rapid review of published literature on the efficacy and safety of this procedure. The evidence included one randomised controlled trial (reported in 3 publications), 13 non-randomised comparative studies, one cohort study, two systematic reviews, and seven case reports. Data from the National Cancer Registration and Analysis Service were also reviewed.
NICE concluded that further research, preferably in the form of randomised controlled trials, should describe details of patient selection, tumour histology and size, and surgical technique, and report overall survival, disease-free survival, tumour recurrence, and patient‑reported outcome measures.
