The LACC (Laparoscopic Approach to Cervical Cancer) trial published in NEJM 2018 fundamentally changed surgical management of early cervical cancer. Its key finding was:
- A Minimally invasive radical hysterectomy had equivalent disease-free survival to open surgery
- B Laparoscopic surgery reduced intraoperative blood loss without affecting survival
- C Minimally invasive radical hysterectomy was associated with significantly lower disease-free and overall survival compared to open surgery ✓
- D Robotic-assisted surgery was superior to standard laparoscopy for radical hysterectomy
Correct answer: C. Minimally invasive radical hysterectomy was associated with significantly lower disease-free and overall survival compared to open surgery
Explanation
The LACC trial (Ramirez et al., NEJM 2018) demonstrated that minimally invasive radical hysterectomy was associated with significantly lower rates of disease-free survival (91% vs 97.1% at 4.5 years) and overall survival compared to open radical hysterectomy in Stage IA1–IB1 cervical cancer. This led to a major shift back toward open surgery as the standard of care for radical hysterectomy in cervical cancer. Uterine manipulator use during laparoscopy was implicated as a possible mechanism.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.