The KEYS trial and the LACC trial (2018) changed the surgical management of cervical cancer. The LACC trial compared minimally invasive radical hysterectomy (MIS-RH) versus open radical hysterectomy (ORH) in Stage IA2–IB1 cervical cancer and found significantly worse disease-free survival in the MIS group. What is the currently recommended surgical approach for early-stage cervical cancer (Stage IB1) based on this evidence?

• A Laparoscopic radical hysterectomy is equivalent to open surgery and should be preferred to reduce morbidity
• B Robotic-assisted radical hysterectomy is preferred as it avoids uterine manipulator use
• C Vaginal radical hysterectomy with pelvic node dissection is the recommended approach
• D Open (abdominal) radical hysterectomy (Wertheim's) remains the standard of care ✓

Explanation

The LACC trial (2018) showed that minimally invasive radical hysterectomy (laparoscopic or robotic) was associated with significantly lower 4.5-year disease-free survival (91% vs 97%) and higher rates of locoregional recurrence compared to open radical hysterectomy. The proposed mechanisms include uterine manipulation causing peritoneal tumour dissemination and CO2 pneumoperitoneum effects. As a result, open (abdominal) radical hysterectomy (Wertheim's hysterectomy) is now the recommended standard of care for early-stage cervical cancer, unless MIS is used within a clinical trial setting.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.