Introduction: With the expansion of value-based medicine, we explore whether using type III
hysterectomy to treat low-risk, early-stage
cervical cancer constitutes overtreatment. In present study, we evaluate the midterm safety and postoperative quality of life of patients who underwent type II
hysterectomy vs. type III
hysterectomy with systematic
lymphadenectomy for low-risk early-stage
cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) IA2-IB1; maximum
tumor diameter < 2 cm). Patients and methods: The main study was a multicenter, phase III, randomized controlled trial (NCT02368574, https://www.clinicaltrials.gov/ct2/show/NCT02368574). Patients meeting the criteria were randomly divided into type II and type III
hysterectomy groups between 2015 and 2018. Midterm outcomes were analyzed at 36 months after the first eligible patient was enrolled. The primary end point was disease-free survival, and the secondary end point was postoperative quality of life. Results: A total of 97 patients were preliminarily enrolled, 93 of whom were included in the final analysis. The general information of the two groups did not differ. The 2-year DFS rate in the type II group was 100% compared with 97.9% in the type III group (P > 0.05). Compared to the type III group, the patients who underwent type II
hysterectomy showed a shorter
surgical time (163 ± 18.8 min vs. 226 ± 16.4 min, P = 0.014), less intraoperative blood loss (174 ± 27.7 ml vs. 268 ± 37.4 ml, P = 0.047), less postoperative
urinary retention (5/46 vs. 11/47 cases, P = 0.109), and milder bladder
injuries. The postoperative symptom experience scores of the type II group were significantly lower than those of the type III group. Moreover, the postoperative sexual/vaginal functioning and lubrication scores of the type II group were significantly lower than those of the type III group in subgroup analyses of patients who did not undergo postoperative
chemoradiotherapy. Sexual apprehension scores were increased postoperatively in both groups. Conclusion: Based on the midterm analysis, the two groups show considerable security within 2 years after surgery, but long-term security requires further analysis. Type II
hysterectomy can effectively reduce the
surgical time and intraoperative blood loss, decrease postoperative complications, and improve the quality of life of early-stage
cervical cancer patients.