Analysis of the temporal changes in management of early-stage cervical cancer over a 10-year period in Germany: a multicenter retrospective analysis of the JAGO/NOGGO.

BACKGROUND

Surgical management of early-stage cervical cancer has evolved substantially over the past decade. While the LACC trial raised concerns regarding minimally invasive radical hysterectomy, real-world practice continues to include radical, non-radical, and fertility-sparing approaches. This study evaluated operative strategies and temporal trends in Germany, particularly regarding the impact of the LACC trial.

METHODS

This retrospective multicenter study included 391 patients with early-stage cervical cancer (≤pT1, pN0, FIGO < IB1) treated at four German university hospitals between 2014 and 2024. Demographic, surgical, perioperative, oncologic, and follow-up data were analyzed descriptively, focusing on temporal changes in surgical management.

RESULTS

The median age at diagnosis was 44 years, and 95.9% of patients had an ECOG performance status of 0-1. Pathological staging revealed pT1b1 tumors in 56.0% of cases, while microinvasive disease (pT1a1-a2) accounted for 35.3%. Laparoscopic approaches declined from 66.5% before 2019 to 50.0% thereafter following publication of the LACC trial in 2018 (p < 0.001), with a corresponding increase in open surgery. Fertility-sparing procedures remained stable (conization 11.3%, trachelectomy 7.4%). Perioperative morbidity was low, with no postoperative complications in 84.4% of patients. Disease recurrence occurred in 5.9% of patients.

CONCLUSIONS

This multicenter study provides a comprehensive overview of contemporary surgical management of early-stage cervical cancer in Germany. Surgical practice changed substantially over time, likely reflecting the combined influence of emerging clinical evidence, evolving guideline recommendations, and changing treatment paradigms; however, no uniform operative standard has emerged. Favorable perioperative and oncologic outcomes across approaches highlight the importance of patient selection and surgical expertise in contemporary cervical cancer care.