The LACC trial (Laparoscopic Approach to Cervical Cancer trial) changed surgical practice for early-stage cervical cancer. What was its primary finding?

• A Laparoscopic radical hysterectomy had equivalent 4.5-year disease-free survival to open surgery
• B Laparoscopic radical hysterectomy was associated with significantly lower 4.5-year disease-free and overall survival compared with open surgery ✓
• C Laparoscopic surgery reduced blood loss and complications without affecting oncological outcomes
• D Robotic-assisted radical hysterectomy outperformed both laparoscopic and open approaches

Explanation

The LACC trial (NEJM, 2018) compared minimally invasive (laparoscopic/robotic) versus open radical hysterectomy in stage IA2-IB1 cervical cancer and found that minimally invasive surgery was associated with significantly lower disease-free survival (91.2% vs 97.1%) and overall survival at 4.5 years. This led to major practice change — open radical hysterectomy is now the standard of care for early cervical cancer, reversing a decade of widespread laparoscopic adoption.

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

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