{"entity":{"id":"lacc","kind":"trial","name":"LACC (Laparoscopic Approach to Cervical Cancer)","aka":[],"tldr":"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.","status":"negative","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT00614211","url":"https://clinicaltrials.gov/study/NCT00614211"},{"label":"NEJM 2018","url":"https://www.nejm.org/doi/full/10.1056/NEJMoa1806395"}],"tags":["failure","lesson:surgical-technique"],"related":[],"cancers":["cervical","early-cervical-cancer"],"sections":[],"technologies":["robotic-surgery"],"targets":[],"drugs":[],"companies":[],"institutions":["md-anderson"],"pathways":[],"terms":[],"trials":[],"people":["pedro-ramirez"],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT00614211","phase":"3","setting":"Early-stage cervical cancer (IA1 with LVSI to IB1): minimally invasive vs open radical hysterectomy","sponsor":"MD Anderson","result":"4.5-year DFS 86.0% vs 96.5%; death HR 6.00 with MIS.","started":"2008-01","startedType":"actual","yearReported":2018,"enrolled":636,"enrolledBasis":"registry","outcomes":[{"endpoint":"Disease-free survival at 4.5 years","primary":true,"unit":"%","arms":[{"name":"Minimally invasive","n":319,"value":86},{"name":"Open surgery","n":312,"value":96.5}],"hr":3.74,"ci":[1.63,8.58],"source":"https://www.nejm.org/doi/full/10.1056/NEJMoa1806395"},{"endpoint":"Overall survival at 3 years","unit":"%","arms":[{"name":"Minimally invasive","value":93.8},{"name":"Open surgery","value":99}],"hr":6,"ci":[1.77,20.3],"source":"https://www.nejm.org/doi/full/10.1056/NEJMoa1806395"}],"replication":"Confirmed by the SEER/NCDB cohort (Melamed, NEJM 2018) and the SUCCOR European cohort."},"route":"/trials/lacc/","neighbours":{"cancer":[{"id":"cervical","kind":"cancer","name":"Cervical cancer","route":"/cancers/cervical/"},{"id":"early-cervical-cancer","kind":"cancer","name":"Early cervical cancer and fertility-sparing surgery","route":"/cancers/early-cervical-cancer/"}],"technology":[{"id":"robotic-surgery","kind":"technology","name":"Robotic & minimally invasive surgery","route":"/technologies/robotic-surgery/"}],"institution":[{"id":"md-anderson","kind":"institution","name":"MD Anderson Cancer Center","route":"/institutions/md-anderson/"},{"id":"sgo","kind":"institution","name":"Society of Gynecologic Oncology","route":"/institutions/sgo/"}],"person":[{"id":"pedro-ramirez","kind":"person","name":"Pedro T. Ramirez","route":"/people/pedro-ramirez/"}],"pairing":[{"id":"caution-mis-radical-hysterectomy","kind":"pairing","name":"Caution: minimally invasive radical hysterectomy for early cervical cancer","route":"/pairings/caution-mis-radical-hysterectomy/"}],"bottleneck":[{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}],"paper":[{"id":"paper-lacc-nejm-2018","kind":"paper","name":"LACC: minimally invasive versus open radical hysterectomy for early cervical cancer","route":"/key-papers/paper-lacc-nejm-2018/"}],"roadmap":[{"id":"surgery-roadmap","kind":"roadmap","name":"Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work","route":"/roadmaps/surgery-roadmap/"}]}}