A multicenter, randomized, noninferiority trial compared simple hysterectomy with radical hysterectomy in patients with low-risk, early-stage cervical cancer. The study included 700 patients with tumors measuring ≤2 cm and limited stromal invasion. The primary outcome was pelvic recurrence at 3 years, with a noninferiority margin of 4 percentage points. The incidence of pelvic recurrence was 2.52% in the simple hysterectomy group and 2.17% in the radical hysterectomy group, with an absolute difference of 0.35 percentage points. Results were similar in a per-protocol analysis. Simple hysterectomy was associated with a lower risk of urinary incontinence and retention compared to radical hysterectomy. The study found that simple hysterectomy was noninferior to radical hysterectomy in terms of pelvic recurrence at 3 years and was associated with fewer urologic complications. The trial was funded by the Canadian Cancer Society and others. The results suggest that simple hysterectomy may be a safe and effective alternative to radical hysterectomy for patients with low-risk cervical cancer.A multicenter, randomized, noninferiority trial compared simple hysterectomy with radical hysterectomy in patients with low-risk, early-stage cervical cancer. The study included 700 patients with tumors measuring ≤2 cm and limited stromal invasion. The primary outcome was pelvic recurrence at 3 years, with a noninferiority margin of 4 percentage points. The incidence of pelvic recurrence was 2.52% in the simple hysterectomy group and 2.17% in the radical hysterectomy group, with an absolute difference of 0.35 percentage points. Results were similar in a per-protocol analysis. Simple hysterectomy was associated with a lower risk of urinary incontinence and retention compared to radical hysterectomy. The study found that simple hysterectomy was noninferior to radical hysterectomy in terms of pelvic recurrence at 3 years and was associated with fewer urologic complications. The trial was funded by the Canadian Cancer Society and others. The results suggest that simple hysterectomy may be a safe and effective alternative to radical hysterectomy for patients with low-risk cervical cancer.