# LACC (Laparoscopic Approach to Cervical Cancer)

Source: https://onco.cc/trials/lacc/  
OnCo record `lacc` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Keyhole surgery, assumed equivalent, turned out to be worse: more recurrences and more deaths than open surgery, reversing practice overnight.

## Summary

4.5-year disease-free survival 86.0% vs 96.5% and OS HR for death 6.00 with minimally invasive surgery (NEJM 2018); the final analysis (2024) confirmed inferiority. Guidelines now recommend open radical hysterectomy; tumour spillage from uterine manipulators and CO2 is the leading hypothesis. Trials of protective manoeuvres (RACC, ROCC) are ongoing.

## Fields

- Kind: Trial
- Status: negative
- Last checked: 2026-09-07
- Tags: failure; lesson:surgical-technique
- Registry id: NCT00614211
- Phase: 3
- Setting: Early-stage cervical cancer (IA1 with LVSI to IB1): minimally invasive vs open radical hysterectomy
- Sponsor: MD Anderson
- Enrolled: 636
- Result: 4.5-year DFS 86.0% vs 96.5%; death HR 6.00 with MIS.
- Outcomes: Disease-free survival at 4.5 years: Minimally invasive 86% vs Open surgery 96.5%, HR 3.74; Overall survival at 3 years: Minimally invasive 93.8% vs Open surgery 99%, HR 6
- Replication: Confirmed by the SEER/NCDB cohort (Melamed, NEJM 2018) and the SUCCOR European cohort.

## Sources

- ClinicalTrials.gov NCT00614211: https://clinicaltrials.gov/study/NCT00614211
- NEJM 2018: https://www.nejm.org/doi/full/10.1056/NEJMoa1806395

## Connected records

- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/), [Early cervical cancer and fertility-sparing surgery](https://onco.cc/cancers/early-cervical-cancer/)
- technologies: [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/)
- institutions: [MD Anderson Cancer Center](https://onco.cc/institutions/md-anderson/), [Society of Gynecologic Oncology](https://onco.cc/institutions/sgo/)
- people: [Pedro T. Ramirez](https://onco.cc/people/pedro-ramirez/)
- pairings: [Caution: minimally invasive radical hysterectomy for early cervical cancer](https://onco.cc/pairings/caution-mis-radical-hysterectomy/)
- bottlenecks: [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)
- key papers: [LACC: minimally invasive versus open radical hysterectomy for early cervical cancer](https://onco.cc/key-papers/paper-lacc-nejm-2018/)
- roadmaps: [Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work](https://onco.cc/roadmaps/surgery-roadmap/)

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