American College of Radiology ACR Appropriateness Criteria ROLE OF ADJUVANT THERAPY IN THE MANAGEMENT OF EARLY STAGE CERVICAL CANCER Expert Panel on Radiation Oncology–Gynecology:

Background on Surgical Management For over 100 years, radical hysterectomy has been the preferred surgical method for treating early (International Federation of Gynecology and Obstetrics [FIGO] clinical stages I and II) cervical carcinoma. The first radical hysterectomy operation was described by John G. Clark, resident gynecologist under Howard Kelly at the Johns Hopkins Hospital in 1895. In a pathological examination of 20 cases treated by hysterectomy, Clark found that the disease had extended past the margins of resection in 15 cases. Influenced by the surgical doctrines of William Halsted, he developed an operative technique that is today recognized as the first true radical hysterectomy [1]. The operation was modified and popularized by Ernst Wertheim, whose experience was impressive in magnitude, completeness of patient follow-up, and descriptions of complications associated with the procedure [2]. Procedural modifications were later introduced by Okabayaski (isolation of the rectum and resection of the cardinal and uterosacral ligaments prior to the anterior dissection) and by Schauta (radical vaginal approach) [3,4]. Liu and Meigs [5] reinvigorated interest in primary surgical treatment of cervical cancer with reported 5-year survival rates >75% and no operative