For a patient with FIGO Stage IB2 cervical squamous cell carcinoma (4.5 cm tumor, no parametrial invasion, no lymph node metastasis on PET-CT), the LACC trial outcome has influenced which clinical practice decision?

• A Minimally invasive radical hysterectomy (laparoscopic/robotic) should be avoided due to significantly worse disease-free and overall survival compared to open surgery ✓
• B Concurrent chemoradiation is preferred over radical hysterectomy for Stage IB2 regardless of surgical approach
• C Laparoscopic sentinel node biopsy followed by open radical hysterectomy is the new standard approach
• D Robotic radical hysterectomy is equivalent to open surgery but laparoscopic approach shows inferior outcomes

Explanation

The LACC (Laparoscopic Approach to Cervical Cancer) trial (NEJM 2018) was a landmark RCT demonstrating significantly lower disease-free survival (91.2% vs 97.1% at 4.5 years) and higher recurrence rates with minimally invasive radical hysterectomy (laparoscopic or robotic) compared to open radical hysterectomy for early-stage cervical cancer. This finding reversed existing trends, and current NCCN and ESMO guidelines now recommend open radical hysterectomy as the standard of care. Both laparoscopic and robotic approaches showed inferior outcomes, disproving the assumption that robotic might be equivalent.

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

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Written and medically reviewed by the StethoPrep medical team.