A 42-year-old woman with FIGO 2018 Stage IB2 cervical squamous cell carcinoma (4.5 cm tumour confined to cervix, no lymph node involvement on imaging) is being counselled. According to LACC trial data published in 2018, which surgical approach is now discouraged as primary treatment?
- A Minimally invasive (laparoscopic or robotic) radical hysterectomy ✓
- B Open radical hysterectomy (Wertheim's)
- C Neoadjuvant cisplatin-based chemotherapy followed by surgery
- D Concurrent chemoradiation with cisplatin
Explanation
The LACC trial (Laparoscopic Approach to Cervical Cancer, NEJM 2018) was a landmark RCT that found minimally invasive radical hysterectomy (laparoscopic or robotic) was associated with significantly lower disease-free survival (91.2% vs 97.1%) and overall survival compared to open radical hysterectomy for early-stage cervical cancer. The proposed mechanism is CO2-induced tumour cell dissemination or uterine manipulator use. Based on this trial, laparoscopic/robotic radical hysterectomy is now discouraged; open Wertheim's hysterectomy remains the surgical standard for eligible patients with early-stage disease.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.