Background
Cervical cancer is a major health concern for women around the world, especially in countries with limited access to healthcare. Early detection through regular Pap smears and HPV tests can help prevent it or catch it early when it’s easier to treat. For many years, doctors treated early-stage cervical cancer by performing a surgery called radical hysterectomy. This surgery removes the uterus, part of the cervix, and nearby tissues. Traditionally, this was done through open surgery, where doctors make a large incision in the abdomen.
However, advances in minimally invasive surgery (MIS), such as laparoscopy (small incisions using a camera) and robotic-assisted surgery, have made it possible to perform the same operation with much smaller cuts, potentially leading to faster recovery times. Many surgeons thought this would be a better option.
The LACC Trial
The LACC Trial (Laparoscopic Approach to Cervical Cancer) was a major study that aimed to compare the outcomes of minimally invasive surgery (MIS) with traditional open surgery for women with early-stage cervical cancer. The trial started in 2008 and involved 631 patients from multiple hospitals around the world. These women were randomly assigned to one of two groups: one group had traditional open surgery, and the other group had the minimally invasive (laparoscopic or robotic) surgery.
The trial continued until 2017 and was designed to see which surgical method was better in terms of cancer returning and overall survival. The women in the trial were closely monitored to track how they were doing after surgery.
Outcome of the LACC Trial
The results of the LACC trial were unexpected and had a major impact on how doctors treat cervical cancer. Here are the key findings:
• Higher Risk of Cancer Coming Back: Women who had minimally invasive surgery were 3-4 times more likely to have their cancer return compared to those who had open surgery. In numbers, about 9% of women in the minimally invasive group saw their cancer come back, compared to only 5% in the open surgery group.
• Lower Survival Rates: The survival rates for women who had minimally invasive surgery were lower. The risk of dying from cervical cancer was four times higher in the minimally invasive group. After 4 years, around 93% of women who had open surgery were still alive, compared to 86% of those who had minimally invasive surgery.
Because of these surprising results, the trial was stopped early in 2017 to avoid putting more women at risk. The findings showed that the open surgery was actually safer in terms of preventing the cancer from coming back and improving survival.
Conclusion
The LACC trial changed the way doctors think about treating early-stage cervical cancer. Before the trial, many surgeons believed that minimally invasive surgery was the better option because it involved smaller cuts, faster recovery, and fewer immediate complications. However, the trial showed that in the long term, this approach led to worse outcomes for many women. As a result, most doctors now recommend open abdominal surgery for early-stage cervical cancer.
It’s important for women facing cervical cancer treatment to discuss their options with their doctors, considering both the short-term benefits and the long-term risks. Research like the LACC trial helps ensure that cancer treatments are based on the best evidence available, improving care for patients everywhere.
Reference:
1. Ramirez, P. T., Frumovitz, M., Pareja, R., Lopez, A., Vieira, M., Ribeiro, R., Buda, A., Yan, X., Shuzhong, Y., Chetty, N., Isla, D., Tamura, M., Zhu, T., Robledo, K. P., Gebski, V., Asher, R., Behan, V., Nicklin, J. L., Coleman, R. L., & Obermair, A. (2018). Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. The New England journal of medicine, 379(20), 1895–1904. https://doi.org/10.1056/NEJMoa1806395
2. Ramirez, P. T., Robledo, K. P., Frumovitz, M., Pareja, R., Ribeiro, R., Lopez, A., Yan, X., Isla, D., Moretti, R., Bernardini, M. Q., Gebski, V., Asher, R., Behan, V., Coleman, R. L., & Obermair, A. (2024). LACC Trial: Final Analysis on Overall Survival Comparing Open Versus Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 42(23), 2741–2746. https://doi.org/10.1200/JCO.23.02335