Cervical cancer is one of the most common gynecologic malignancies worldwide, with radical hysterectomy representing the cornerstone of surgical management for early-stage disease. The past decade has witnessed profound shifts in the surgical paradigm, driven primarily by the LACC trial, which demonstrated significantly inferior disease-free survival with minimally invasive surgery (MIS) compared to open radical hysterectomy. Subsequent analyses, including the SUCCOR study, implicated uterine manipulator use and unprotected colpotomy as important technical factors associated with occurrence, suggesting that operative technique may have contributed to the inferior oncologic outcomes observed after MIS. Concurrently, evolving evidence has supported surgical de-escalation strategies in carefully selected patients: the SHAPE trial established the non-inferiority of simple hysterectomy compared with radical hysterectomy in low-risk stage IB1 disease, while fertility-sparing approaches (including radical trachelectomy and large-cone excision) continue to gain acceptance among young women with early-stage tumors. Sentinel lymph node biopsy has emerged as a validated, lower-morbidity alternative to systematic pelvic lymphadenectomy. The integration of tumor biology, imaging, and molecular profiling is increasingly guiding personalized surgical planning, with particular attention to histologic subtype and lymphovascular space invasion status. This review critically examines the current evidence for MIS, de-escalation, and individualized surgical strategies in cervical cancer, synthesizing data from randomized trials, prospective registries, and meta-analyses to provide a comprehensive framework for contemporary clinical decision-making.