The trend of utilizing de-escalation of surgical extent for treating early-stage cervical cancer patients

Sep 29, 2026

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Editorial commentary on the evolving use of de-escalation strategies in the surgical treatment of early-stage cervical cancer, emphasizing the need to maintain oncologic safety while improving practical outcomes. It summarizes global and local cervical cancer burdens, the WHO 90-70-90 framework, and highlights a study of 107 patients comparing sentinel lymph node mapping and biopsy with conventional pelvic/para-aortic lymph node dissection. Comparable 3-year disease-free and overall survival, fewer harms, and potential clinical value are discussed in context of guideline adherence and quality-of-life considerations.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

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Editorial

Global burden and treatment framework

Retrospective comparison of SLNMB vs SOC LND

Clinical implications and balancing efficacy with adverse events

J Chin MedAssoc Editorial The trend of utilizing de-escalation of surgical extent for treating early-stage cervical cancer patients Szu-Ting Yanga,b, Peng-Hui Wanga,b,c,* Chia-Hao Liua,b aDepartment of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cFemale Cancer Foundation, Taipei, Taiwan, ROC Cervical cancer (CC) is a global health problem, particularly in low- and middle-income countries (LMICs) . In these regions, women often lack timely access to human papillomavirus (HPV) vaccination and effective screening tests (such as cytology, HPV testing, or combined testing) . More importantly, many women diagnosed with CC cannot receive adequate treatment, leading to 80% of CC incidence and 90% of CC deaths occurring in LMICs.1–3 Taiwan, although it has been classified as a developed country, also faces the biggest challenge in this issue.1 The newest report from the Taiwan Health Promotion Administration (HPA) shows that CC ranks among the top ten cancers affecting women in Taiwan, with an incidence of occurrence and death ranking 9 and 8, respectively.4 To cut down on CC-associated socioeconomic burden and solve global health problems, the World Health Organization (WHO) has launched the 90-70-90 strategy in an attempt to reduce CC incidence to fewer than four new cases per 100,000 women by 90% vaccination rate to the girls before 15 years of age, 70% effective screening rate to women at 35 and 45 years of age, and 90% appropriate treatment rate to the diseased women.5 Among three main approaches, appropriate therapy not only plays a rescue method to save patients’ life when CC has escaped the protection offered by vaccination and screening but also offers a better chance to cure the disease without compromising quality of life (QoL) .2,3,6 However, to reach the maximal benefit-to-risk ratio, many obstacles should be overcome, partly because oncologic safety (the maximal therapeutic efficacy) is always the priority before making any changes to the established standard of care (SOC) therapy.7,8 We are very happy to introduce Drs. Ting and Hsiao’s study published in the March 2025 issue of the Journal of Chinese Medical Association (JCMA) to discuss this issue.9 Drs. Ting and Hsiao retrospectively enrolled 107 women with CC undergoing radical surgery (hysterectomy or trachelectomy) for primary tumor and plus either sentinel lymph node mapping and biopsy *Address correspondence. Dr. Peng-Hui Wang, Department of Obstetricsand Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail addresses: phwang@vghtpe.gov.tw](ROC. E-mail addresses: phwang@vghtpe.gov.tw); [pongpongwang@gmail.com](pongpongwang@gmail.com) (P.-H. Wang). Conflicts of interest: Dr. Peng-Hui Wang, an editorial board member at the Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2025) 88: 657-659. Received May 27, 2025; accepted June 2, 2025. doi: 10. 1097/JCMA.0000000000001272 Copyright © 2025, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/)) (SLNMB) (n = 33) or conventional SOC pelvic/para-aortic lymph node dissection (LND) (n = 74) to investigate the oncological outcome between the two groups.9 The results showed both 3-year disease-free survival (DFS) and 3-year overall survival (OS) rates were similar between the SLNMB and SOCLND groups without statistically significant differences (87.6% vs 82.9% and 100% vs 91.0%, respectively) .9 Addi

FAQs

What is the main treatment goal discussed for early-stage cervical cancer surgery?

The discussion centers on maximizing benefit while preserving oncologic safety when modifying the established standard of care, aiming to avoid compromising therapeutic efficacy.

How do the reported survival outcomes compare between SLNMB and conventional SOC lymph node dissection?

The editorial reports similar 3-year disease-free survival and overall survival rates between the SLNMB and SOC LND groups, with no statistically significant differences.

What potential advantages does SLNMB offer based on the summary provided?

The editorial notes that SLNMB is associated with less blood loss and a shorter hospital stay compared with conventional SOC LND, alongside comparable survival and oncologic safety.

Sep 29, 2026

Uploaded by Finn