The LACC trial (2018) compared minimally invasive radical hysterectomy (laparoscopic/robotic) to open radical hysterectomy for early-stage cervical cancer. What was its landmark finding and how did it change practice?
- A Minimally invasive surgery had equivalent disease-free survival, confirming its safety
- B Minimally invasive surgery was associated with lower disease-free survival (DFS) and higher local recurrence, shifting standard of care back to open surgery ✓
- C Robotic surgery was superior to laparoscopic but both were inferior to open approach
- D Minimally invasive surgery was superior in stage IA2 but inferior in IB1
Correct answer: B. Minimally invasive surgery was associated with lower disease-free survival (DFS) and higher local recurrence, shifting standard of care back to open surgery
Explanation
The LACC trial (Lancet, 2018) was a landmark RCT showing that minimally invasive radical hysterectomy (laparoscopic and robotic combined) for stage IA2-IB1 cervical cancer was associated with significantly lower 4.5-year DFS (91.2% vs 97.1%) and higher local recurrence rates compared to open abdominal radical hysterectomy. This finding, unexpected at the time, led to an immediate shift back toward open radical hysterectomy as the standard approach, and international guidelines (ESGO, NCCN, SGO) were updated accordingly.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.