{"entity":{"id":"paper-lacc-nejm-2018","kind":"paper","name":"LACC: minimally invasive versus open radical hysterectomy for early cervical cancer","aka":[],"tldr":"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.\n\nDisease-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.","asOf":"2026-09-17","links":[{"label":"N Engl J Med 2018","url":"https://doi.org/10.1056/NEJMoa1806395"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/30380365/"}],"tags":[],"related":[],"cancers":["early-cervical-cancer"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["lacc"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2018,"doi":"10.1056/NEJMoa1806395","pmid":"30380365","authors":"Ramirez PT, Frumovitz M, Pareja R, et al.","paperType":"rct","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."],"whatItMeans":"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."],"changedPractice":true,"participants":631},"route":"/key-papers/paper-lacc-nejm-2018/","neighbours":{"cancer":[{"id":"early-cervical-cancer","kind":"cancer","name":"Early cervical cancer and fertility-sparing surgery","route":"/cancers/early-cervical-cancer/"}],"trial":[{"id":"lacc","kind":"trial","name":"LACC (Laparoscopic Approach to Cervical Cancer)","route":"/trials/lacc/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}]}}