{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T07:21:14Z","timestamp":1789802474278,"version":"4.0.1"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Four recent prospective trials demonstrated that de\u2010escalation of radical surgery for select patients with apparent low\u2010risk, FIGO Stage I cervical cancer does not compromise cancer\u2010related survival but does improve quality of life and provide the opportunity to preserve fertility. We present a critical review of ConCerv, SHAPE, GOG\u2010278, and LESSER, which have set the stage for de\u2010escalation of surgery for low\u2010risk, early\u2010stage cervical cancer. ConCerv, a prospective phase II study evaluating the feasibility and oncologic outcomes of conization alone or simple hysterectomy in patients with early\u2010stage cervical carcinoma, found a low recurrence rate of 2.4% in patients who underwent a cone biopsy with lymph node assessment and 0% in those who underwent simple hysterectomy with lymph node evaluation. SHAPE, a phase III trial assessing the safety of simple hysterectomy compared to radical hysterectomy in this patient population, showed no difference in pelvic recurrences between both groups. GOG\u2010278, an international cohort study evaluating the efficacy of cone biopsy versus simple hysterectomy with pelvic nodal assessment, found a 3\u2010year recurrence\u2010free survival rate of 94.8% in the cone biopsy group, with no recurrences noted in the simple hysterectomy group. Finally, LESSER, a phase II proof\u2010of\u2010concept trial studying cancer and quality\u2010of\u2010life outcomes in patients who underwent either a simple or modified radical hysterectomy for early\u2010stage cervical cancer, found no difference in the disease\u2010free survival rate or overall survival between both groups. Rates of postoperative complications were also similar in both arms. Based on these trials, we propose the following set of criteria for which de\u2010escalation of surgical intervention would be appropriate for select Stage I disease: tumors \u22642\u2009cm on cone biopsy; magnetic resonance imaging showing &lt;50% of cervical stromal invasion with no evidence of metastasis; and a histology of either squamous cell carcinoma of any grade or either grade 1 or 2 adenocarcinoma, with depth of invasion &lt;10\u2009mm and no lymphovascular invasion.<\/jats:p>","DOI":"10.1002\/ijgo.71230","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T20:16:13Z","timestamp":1785183373000},"page":"1181-1187","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["De\u2010escalating radical surgery for select\n                    <scp>FIGO<\/scp>\n                    Stage I cervical cancer"],"prefix":"10.1002","volume":"174","author":[{"given":"Sara","family":"Moufarrij","sequence":"first","affiliation":[{"name":"Department of Surgery, Gynecology Service Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Pareja","sequence":"additional","affiliation":[{"name":"Cl\u00ednica de Oncolog\u00eda Astorga  Medell\u00edn Colombia"},{"name":"Department of Gynecologic Oncology Instituto Nacional de Cancerolog\u00eda  Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ang\u00e9lica","family":"Fletcher","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology Instituto Nacional de Cancerolog\u00eda  Bogot\u00e1 Colombia"},{"name":"Division of Gynecologic Oncology Cl\u00ednica Internacional de Alta Tecnolog\u00eda\u2010CLINALTEC  Inbagu\u00e9 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarikapan","family":"Wilailak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadeem R.","family":"Abu\u2010Rustum","sequence":"additional","affiliation":[{"name":"Department of Surgery, Gynecology Service Memorial Sloan Kettering Cancer Center  New York New York USA"},{"name":"Department of Obstetrics and Gynecology Weill Cornell Medical College  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the FIGO Committee on Women's Cancer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"World health Organization.Cervical Cancer Elimination 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