# LACC: minimally invasive versus open radical hysterectomy for early cervical cancer

Source: https://onco.cc/key-papers/paper-lacc-nejm-2018/  
OnCo record `paper-lacc-nejm-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Against expectations, keyhole radical hysterectomy for early cervical cancer led to more recurrences and more deaths than open surgery, reversing a decade of practice towards laparoscopic and robotic operations.

## Summary

Phase 3 non-inferiority trial of 631 women with stage IA1 (with lymphovascular invasion) to IB1 cervical cancer randomised to minimally invasive (laparoscopic or robotic) or open abdominal radical hysterectomy.

Disease-free survival at 4.5 years was 86.0 percent with minimally invasive surgery against 96.5 percent with open surgery, with a hazard ratio for recurrence of 3.74 and for death of 6.00; the trial was stopped early for harm.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2018
- DOI: 10.1056/NEJMoa1806395
- Authors: Ramirez PT, Frumovitz M, Pareja R, et al.
- Findings: 4.5-year disease-free survival 86.0 percent vs 96.5 percent; hazard ratio for recurrence 3.74.; Hazard ratio for death from any cause 6.00.
- What it means: Open radical hysterectomy is again the standard for early cervical cancer; minimally invasive approaches are used only within protocols that avoid tumour spillage, and the trial is a lesson in adopting surgical innovation without randomised evidence.
- Caveats: Mechanism (uterine manipulator, CO2 insufflation, intracorporeal colpotomy) remains debated.; Surgical technique modifications have not yet been proven safe in randomised trials.

## Sources

- N Engl J Med 2018: https://doi.org/10.1056/NEJMoa1806395
- PubMed: https://pubmed.ncbi.nlm.nih.gov/30380365/

## Connected records

- cancers: [Early cervical cancer and fertility-sparing surgery](https://onco.cc/cancers/early-cervical-cancer/)
- trials: [LACC (Laparoscopic Approach to Cervical Cancer)](https://onco.cc/trials/lacc/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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