# SHAPE: simple versus radical hysterectomy in low-risk early cervical cancer

Source: https://onco.cc/key-papers/paper-shape-nejm-2024/  
OnCo record `paper-shape-nejm-2024` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

For small, low-risk cervical cancers, a simple hysterectomy gave the same very low pelvic recurrence rate as a radical hysterectomy with fewer urinary and sexual complications, so less extensive surgery is now acceptable.

## Summary

Phase 3 non-inferiority trial of 700 women with low-risk cervical cancer (up to 2 cm, limited stromal invasion) randomised to simple hysterectomy or radical hysterectomy, both with pelvic node assessment.

Three-year pelvic recurrence was 2.52 percent with simple hysterectomy and 2.17 percent with radical hysterectomy, within the non-inferiority margin, with fewer urinary incontinence and retention problems and better sexual health after simple hysterectomy.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2024
- DOI: 10.1056/NEJMoa2308900
- Authors: Plante M, Kwon JS, Ferguson S, et al.
- Findings: Three-year pelvic recurrence 2.52 percent vs 2.17 percent (non-inferior).; Urinary incontinence 2.4 percent vs 5.5 percent within four weeks; urinary retention 0.6 percent vs 11.0 percent.
- What it means: Women with low-risk early cervical cancer can be offered simple hysterectomy, sparing them the bladder and sexual morbidity of parametrectomy, provided strict eligibility criteria are applied.
- Caveats: Strict imaging and pathology criteria define low risk; misapplication to larger tumours would be unsafe.; Longer follow-up is pending.

## Sources

- N Engl J Med 2024: https://doi.org/10.1056/NEJMoa2308900
- PubMed: https://pubmed.ncbi.nlm.nih.gov/38416430/

## Connected records

- cancers: [Early cervical cancer and fertility-sparing surgery](https://onco.cc/cancers/early-cervical-cancer/)
- trials: [SHAPE (CCTG CX.5)](https://onco.cc/trials/shape/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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