Minimally invasive vs. open surgery: comparison of surgical complications in radical hysterectomy for cervical cancer

Cervical cancer remains a significant global health concern, ranking as the third most prevalent malignancy and the second leading cause of cancer-related mortality among women in the United States. Early-stage cervical cancer is typically managed with radical hysterectomy, traditionally performed via open abdominal or vaginal approaches. Minimally invasive radical hysterectomy (MIS-RH) was introduced in 1993, yet findings from the laparoscopic approach to cervical cancer (LACC) trial have raised substantial concerns regarding the oncologic safety of the laparoscopic approach. As a result, abdominal radical hysterectomy (ARH) has been reaffirmed as the standard of care in surgical practice for cervical cancer. Despite this shift, some studies suggest that minimally invasive surgery (MIS), specifically laparoscopic radical hysterectomy (LRH), may be associated with fewer perioperative complications compared to open surgery. However, other studies report no significant differences in complication rates when comparing LRH to ARH. Persistent challenges in adopting MIS for cervical cancer treatment include the complexity of these procedures, extended learning curves, and increased costs. This narrative review provides a comprehensive comparison of LRH and ARH complications, offering insights into their safety, efficacy, and overall benefits to advance the ongoing discussion on optimal surgical approaches for cervical cancer treatment.