Trends of minimally invasive surgery in the primary treatment of cervical cancer

Abstract

Minimally invasive surgery (MIS), including laparoscopic and robot-assisted procedures, has rapidly advanced in the treatment of gynecologic malignancies worldwide. However, its adoption and insurance coverage in AOFOG countries remain limited, particularly for advanced uterine and ovarian cancers. This limitation poses a challenge to the widespread use of MIS, highlighting the need for a more comprehensive evaluation of its role and the skills required by gynecologic oncologists to ensure safe and effective treatment. Furthermore, the Laparoscopic Approach to Cervical Cancer trial significantly impacted perceptions of MIS, revealing higher recurrence rates and inferior overall survival for minimally invasive radical hysterectomy (MIS-RH) compared to abdominal radical hysterectomy. Subsequent studies confirmed these findings, raising questions about the suitability of MIS-RH, particularly in centers with limited experience. Key issues affecting MIS outcomes include surgical expertise and tumor spillage prevention. As the landscape of cervical cancer treatment evolves, the integration of radiotherapy, chemotherapy, and immune therapies has challenged the traditional reliance on surgical monotherapy. There also exists ongoing debate over the optimal use of MIS in primary treatment and salvage surgery for cervical cancer to refine MIS techniques and explore their role in preserving fertility and managing residual disease post-chemoradiotherapy. For ensuring MIS as a viable treatment option, it is continuously necessary accumulating real-world data and reassessing surgical strategies to balance efficacy, safety, and patient preferences.