NICE is advising that minimally invasive radical hysterectomy should not be used to treat early stage cervical cancer in patients for whom open surgery is an appropriate alternative.
In new draft guidance, the agency has concluded that the evidence on minimally invasive radical hysterectomy for early stage cervical cancer shows that there are no short-term safety concerns. However, in the longer-term, the evidence on efficacy demonstrates that the treatment is associated with shorter disease-free and overall survival compared with open hysterectomy.
The NICE appraisal committee was advised that there could be seeding of malignant cells from the cervix during the procedure related to the use of a manipulator to position the cervix, and that this needs further investigation. The committee felt that research into variations in the technique designed to reduce the risk of tumour seeding or other potential causes of long-term tumour recurrence may be appropriate.
However, it was noted that there may be some patients for whom the risks of an open procedure are such that, after careful consideration by a multidisciplinary team and with appropriate patient consent, minimally invasive radical hysterectomy could be offered.
The draft guidance is now open to public consultation. The closing date for receipt of comments is 21 November 2019 and a final decision is expected to be published in February 2020.
