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Caution: minimally invasive radical hysterectomy for early cervical cancer

Keyhole radical hysterectomy, though less painful, led to more recurrences and deaths than open surgery in the LACC trial. Open surgery is the standard until protective techniques are proven.

LACC: 4.5-year DFS 86.0% vs 96.5%, death HR 6.0. Confirmed by cohort studies. Hypotheses: CO2 insufflation and uterine manipulator spread tumour cells. RACC and ROCC trials test manipulator-free, vaginal-closure techniques.

Rationale
Laparoscopic manipulation of the cervix is thought to disseminate tumour cells.
Evidence
Phase 3 (negative for MIS) plus large cohorts.

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